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<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H 2. Ciprofloxacin HCl 500 mg PO Q12H Stop on ___ 3. Collagenase Ointment 1 Appl TP DAILY 4. Daptomycin 750 mg IV Q24H Duration: 6 Weeks Proposed End date: ___ RX *daptomycin 500 mg 1.5 vials IV q24H Disp #*63 Vial Refills:*0 5. Docusate Sodium 100 mg PO BID stop taking if having loose stools 6. Enoxaparin Sodium 60 mg SC Q12H Continue for 4 weeks 7. Gabapentin 300 mg PO TID 8. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*10 Tablet Refills:*0 9. Polyethylene Glycol 17 g PO DAILY:PRN constipation 10. Senna 8.6 mg PO BID stop taking if having loose stools 11. Vitamin D 5000 UNIT PO DAILY 12. Lisinopril 30 mg PO DAILY 13. ALPRAZolam 0.5 mg PO Q6H; PRN anxiety 14. lovastatin 20 mg oral qd 15. Metoprolol Tartrate 25 mg PO BID 16. TraZODone 100 mg PO QHS:PRN insomnia 17. HELD- Aspirin 81 mg PO DAILY This medication was held. Do not restart Aspirin until you complete your course of Lovenox x 28 days Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: L knee dislocation, s/p L TKA reivsion; s/p left knee antibiotic spacer exchange and gastro flap of left knee Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>1. Please return to the emergency department or notify your physician if you experience any of the following: severe pain not relieved by medication, increased swelling, decreased sensation, difficulty with movement, fevers greater than 101.5, shaking chills, increasing redness or drainage from the incision site, chest pain, shortness of breath or any other concerns. 2. Please follow up with your primary physician regarding this admission and any new medications and refills. 3. Resume your home medications unless otherwise instructed. 4. You have been given medications for pain control. Please do not drive, operate heavy machinery, or drink alcohol while taking these medications. As your pain decreases, take fewer tablets and increase the time between doses. This medication can cause constipation, so you should drink plenty of water daily and take a stool softener (such as Colace) as needed to prevent this side effect. Call your surgeons office 3 days before you are out of medication so that it can be refilled. These medications cannot be called into your pharmacy and must be picked up in the clinic or mailed to your house. Please allow an extra 2 days if you would like your medication mailed to your home. 5. You may not drive a car until cleared to do so by your surgeon. 6. Please call your surgeon's office to schedule or confirm your follow-up appointment. 7. SWELLING: Ice the operative joint 20 minutes at a time, especially after activity or physical therapy. Do not place ice directly on the skin. You may wrap the knee with an ace bandage for added compression. Please DO NOT take any non-steroidal anti-inflammatory medications (NSAIDs such as Celebrex, ibuprofen, Advil, Aleve, Motrin, naproxen etc) until cleared by your physician. 8. ANTICOAGULATION: Please continue your Lovenox 60 mg twice daily for four (4) weeks to help prevent deep vein thrombosis (blood clots). 9. WOUND CARE: Please keep dry sterile dressing in place until follow-up visit next week with the Plastics team on ___. You have 1 JP drain in place, which should remain in place until your follow up with the Plastic Surgery & Reconstruction team. All questions and concerns regarding wound care should be directed to their office. See follow up appointment information below. 10. ___ (once at home): Home ___, daily dressing changes and wound checks as instructed by Plastics Surgery & Reconstruction team. 11. ACTIVITY: Toe touch weight bearing on the operative extremity. Two crutches or walker. Knee immobilizer in place at all times. NO ROM. No strenuous exercise or heavy lifting until follow up appointment. 12. PICC CARE: Per protocol 13. WEEKLY LABS: draw on ___ and send result to ID RNs at: ___ R.N.s at ___. - CBC/DIFF - CPK - CHEM 7 - LFTS - ESR/CRP **All questions regarding outpatient parenteral antibiotics should be directed to the ___ R.N.s at ___ or to the on-call ID fellow when the clinic is closed. Current OPAT regimen Daptomycin 750 mg IV Q24H Duration of OPAT regimen Start date: ___ Stop date: ___ Physical Therapy: ***No Range of Motion LLE, knee immobilizer in place at all times locked in extension*** Toe touch weight bearing LLE Mobilize frequently*** Treatments Frequency: **Stage 3 necrotic pressure ulcer of left buttock, s/p sharp excisional debridement x2. Please perform daily dressing changes as below. Site: Left glut Description: Type/Etiology/Stage: Unstageable pressure injury Size: 4.2(L)x4.2(W)x2.0(D)cm, no tunneling or undermining. Wound bed: 50% black/soft eschar and 50% pink/white mix tissue. No fluctuance in wound bed. Wound edges: Unattached Exudate: Small serosang Odor: None detected Periwound tissue: Partial thickness opening extending from ___ o'clock position extending approx. 1cm otherwise blanching erythema. No warmth. Wound Pain: Mild discomfort with cleansing, palpation Care: s/p x2 bedside sharp debridement ___ and ___ with general surgery team Topical therapy: Normal saline to cleanse wound. Pat the tissue dry with dry gauze. Apply THIN layer of criticaid clear barrier ointment to periwound skin (to protect) Apply santyl ointment (nickel thick) to wound bed Gently pack wound with BARELY MOISTENED (with normal saline) 2x2 gauze Secure with pink hy tape (Manf #20) Change dressing daily. Support surface: Mighty Air mattress in place Turn and reposition every ___ hours and prn off affected area Heels off bed surface at all times Waffle Boots ( x ) If OOB, limit sit time to one hour at a time and Sit on a pressure redistribution cushion- ROHO ( x ) Obtain from ___ OR ___ air full length chair cushion ( x) (Obtain from ___ Elevate ___ sitting. Moisturize B/L ___ and feet, intact skin only BID with Sooth And Cool Ointment. *Dressing changes daily* - Normal saline to cleanse wound. Pat the tissue dry with dry gauze. Apply THIN layer of criticaid clear barrier ointment to periwound skin (to protect) Apply santyl ointment (nickel thick) to wound bed Gently pack wound with BARELY MOISTENED (with normal saline) 2x2 gauze Secure with pink hy tape. Change dressing daily. Incontinence care: Please avoid chucks under patient. Cleanse area with commercial foam cleanser and soft disposable cloth. Apply THIN layer of criticaid clear barrier ointment daily and every third cleansing. Can use large softsorb to wick away liquid stool Change daily and as needed. **Please leave knee dressing and JP drain x1 in place until follow up visit in clinic on ___, record output q4H**</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Fish Oil (Omega 3) 1000 mg PO DAILY 2. Labetalol 300 mg PO TID 3. leflunomide *NF* 20 mg Oral daily 4. sevelamer CARBONATE 800 mg PO TID W/MEALS 5. Tacrolimus 3 mg PO QAM 6AM 6. Tacrolimus 2 mg PO QPM 6PM 7. Torsemide 100 mg PO DAILY 8. Rosuvastatin Calcium 5 mg PO DAILY hyperlipidemia Hold if proximal muscle weakness, elevated CK 9. Caltrate 600 + D *NF* (calcium carbonate-vitamin D3) 600 mg(1,500mg) -400 unit Oral qPM 10. Vitamin D 50,000 UNIT PO QMONTH 11. Glargine 13 Units Bedtime Insulin SC Sliding Scale using novolog Insulin 12. Nephrocaps 1 CAP PO DAILY HD RX *Nephrocaps 1 mg 1 Capsule(s) by mouth daily Disp #*30 Capsule Refills:*3 13. Losartan Potassium 100 mg PO DAILY HTN Hold for SBP<100. RX *losartan 100 mg 1 Tablet(s) by mouth one time per day Disp #*30 Tablet Refills:*3 Discharge Disposition: Home Discharge Diagnosis: primary diagnosis: graft thrombosis secondary diagnosis: ESRD Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of ___ while ___ were hospitalized at the ___ were transferred here because your dialysis graft was not able to be accessed. ___ underwent an imaging procedure called a fistulogram so that our interventional radiologists could determine whether there was in fact flow through your dialysis graft. When they discovered that there was no flow because of a clot, they were able to perform a procedure called a thrombectomy to remove the clot. The thrombectomy was successful and the flow through your graft was confirmed when ___ received hemodialysis on ___. Your dialysis session went very well. Our nephrologists recommended that ___ start vitamins called nephrocaps for patients on hemodialysis. ___ may also need to start a medication called erythropoietin with hemodialysis so to help ___ produce red blood cells. Weigh yourself every morning, call MD if weight goes up more than 3 lbs.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN pain 2. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN wheeze 3. Bisacodyl 10 mg PO/PR DAILY:PRN constipation Hold for loose stools. 4. Calcium Carbonate 500 mg PO TID 5. Docusate Sodium 100 mg PO BID 6. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH HS 7. Lidocaine 5% Patch 1 PTCH TD QAM Apply 12hrs on, 12hrs off. RX *lidocaine [Lidoderm] 5 % (700 mg/patch) place one patch in your arm QAM Disp #*14 Each Refills:*0 8. Senna 17.2 mg PO HS Hold for loose stools. 9. Simvastatin 10 mg PO DAILY 10. TraMADOL (Ultram) 25 mg PO Q6H:PRN pain RX *tramadol 50 mg Half tablet(s) by mouth Q6hr-prn Disp #*56 Tablet Refills:*0 11. Vitamin D 800 UNIT PO DAILY 12. Metoprolol Tartrate 12.5 mg PO Q6H 13. Rivaroxaban 15 mg PO DINNER RX *rivaroxaban [Xarelto] 15 mg One tablet(s) by mouth Daily with the evening meal Disp #*30 Tablet Refills:*0 14. Cephalexin 500 mg PO Q6H RX *cephalexin 500 mg One capsule(s) by mouth Q6hr-prn Disp #*2 Capsule Refills:*0 15. removable long risk splint Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: Subnodal block in the setting of Fixed His-Purkinje Disease. s/p Pacemaker placement. Secondary: Traumatic L distal ulnar fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Miss ___, It was a pleasure to care for you at the ___ ___. You were admitted for an intermittently very slow heart rate causing you to have neurologic symptoms. We believe that this slow heart rate likely caused you to fall, precipitating your arm fracture. While here, you had a pacemaker placed to maintain a normal heart rate. You were seen by Orthopaedics who recommended a sling for your arm, but no operative management. We prescribed you a lidocaine patch to control your back pain. Please see below for your medications and appointments. Thank you for allowing us to participate in your care.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO TID 2. Ciprofloxacin HCl 500 mg PO Q12H Duration: 7 Days RX *Cipro 500 mg 1 tablet(s) by mouth twice a day Disp #*14 Tablet Refills:*0 3. Docusate Sodium 100 mg PO BID 4. HYDROmorphone (Dilaudid) ___ mg PO Q3H:PRN pain RX *hydromorphone 2 mg ___ tablet(s) by mouth every ___ hours as needed Disp #*25 Tablet Refills:*0 5. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H Duration: 7 Days RX *Flagyl 500 mg 1 tablet(s) by mouth three times a day Disp #*21 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Appendicitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital with appendicitis requiring an operation to remove your appendix. You are being treated with a course of antibiotics that you will need to complete as directed. You are being discharged on medications to treat the pain from your operation. These medications will make you drowsy and impair your ability to drive a motor vehicle or operate machinery safely. You MUST refrain from such activities while taking these medications. Please call your doctor or return to the emergency room if you have any of the following: * You experience new chest pain, pressure, squeezing or tightness. * New or worsening cough or wheezing. * If you are vomiting and cannot keep in fluids or your medications. * You are getting dehydrated due to continued vomiting, diarrhea or other reasons. Signs of dehydration include dry mouth, rapid heartbeat or feeling dizzy or faint when standing. * You see blood or dark/black material when you vomit or have a bowel movement. * You have shaking chills, or a fever greater than 101.5 (F) degrees or 38(C) degrees. * Any serious change in your symptoms, or any new symptoms that concern you. * Please resume all regular home medications and take any new meds as ordered. Activity: No heavy lifting of items ___ pounds for 6 weeks. You may resume moderate exercise at your discretion, no abdominal exercises. Wound Care: You may shower, no tub baths or swimming. If there is clear drainage from your incisions, cover with clean, dry gauze. Your steri-strips will fall off on their own. Please remove any remaining strips ___ days after surgery. Please call the doctor if you have increased pain, swelling, redness, or drainage from the incision sites.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. DiphenhydrAMINE 50 mg IV BID RX *diphenhydramine in 0.9 % NaCl 50 mg/50 mL infuse 50mL of 50mg/50mL solution twice daily Disp #*3000 Milliliter Refills:*0 2. Pantoprazole 80 mg IV Q12H RX *pantoprazole [Protonix] 40 mg infuse 40mg IV solution twice daily Disp #*2400 Milligram Refills:*0 3. Doxycycline Hyclate 100 mg IV Q12H MRSA bacteremia, suppression dose day 1 is ___ RX *doxycycline hyclate 100 mg 100mg IV doxycycline twice daily Disp #*600 Milligram Refills:*0 4. Ethanol 70% Catheter DWELL (Tunneled Access Line) 2 mL DWELL DAILY (Tunneled Access Line) 2 mL DWELL DAILY Not for IV use. To be instilled into EACH central catheter port for local dwell daily Right After TPN finishes in AM. Please leave in for 1.5-2 hrs, then Aspirate and Flush with saline and heparin afterwards 5. Fentanyl Patch 75 mcg/h TP Q72H RX *fentanyl [Duragesic] 75 mcg/hour Apply one to skin, change every 72 hours Change every 72 hours Disp #*12 Transdermal Patch Refills:*0 6. Heparin Flush (10 units/ml) 2 mL IV PRN line flush Tunneled Access Line (e.g. ___), heparin dependent: Flush with 10 mL Normal saline followed by Heparin as above daily and PRN per lumen. RX *heparin lock flush (porcine) [Heparin Lock] 10 unit/mL Instill 2mL of 10 unit/mL solution as needed Disp #*1000 Milliliter Refills:*0 7. TPN Volume(ml/d) ___, Amino Acid(g/d) 100, Dextrose(g/d) 400, Fat(g/d) 45. Trace Elements will be added daily. Standard Adult Multivitamins will be added. NaCL 200, NaAc 115, NaPO4 0, KCl 50, KAc 10, KPO4 25, MgS04 32, CaGluc 8. Famotidine(mg) 100, Zinc(mg) 15. Cycle over 18hrs. Start at 1800 Decrease rate to half at 1100, Stop at 1200. 8. catheter dwell Ethanol 70% Catheter DWELL (Tunneled Access Line) 2 mL DWELL DAILY (Tunneled Access Line) 2 mL DWELL DAILY Not for IV use. To be instilled into EACH central catheter port for local dwell daily Right After TPN finishes in AM. Please leave in for 1.5-2 hrs, then Aspirate and Flush with saline and heparin afterwards Dispense 1000mL Duration: Ongoing 9. Outpatient Lab Work Needs weekly CBC, AST/ALT/ALK Phos/T Bili/Alb, Chem 7. Please fax results to Dr. ___. 10. Peridex *NF* (chlorhexidine gluconate) 15 mL PO BID:PRN Reason for Ordering: Wish to maintain preadmission medication while hospitalized, as there is no acceptable substitute drug product available on formulary. RX *chlorhexidine gluconate [Peridex] 0.12 % Mouthwash with 15mL Twice a day Disp #*2 Bottle Refills:*0 11. Miconazole Powder 2% 1 Appl TP BID around G tube per wound care recs RX *miconazole nitrate [Anti-Fungal] 2 % Apply to surrounding wound area Twice a day Disp #*2 Bottle Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: G-TUBE MIGRATION Secondary: Congenital intestinal pseudoobstruction s/p intestinal transplant x2, Upper extremity DVT Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ for migration of your G-tube site and pain around G-tube site. You were seen by the surgery team who decided to take you to the OR and replace the G Tube as well as create a stomach osteomy. You had electrolyte abnormalities which improved with IV fluids. You had fevers and were seen by infectious disease specialists. We used a few different antibiotics which you had adverse reactions to. We eventually treated you for a pnuemonia with Doxycycline (as well as for a suspected MRSA catheter tip infection). You need to take Doxycyline for the suspected catheter tip infection until you see the infectious disease specialist. We do not think you had an infection of the ICD leads (the imaging study did not suggest that). You had substantial pain that was controlled with IV Dilaudid. We weaned you off IV Dilauded as best as we could. Pain Medicine could not make any specific suggestions in light of your inability to take pills by mouth. Of note, we recommended anticoagulation for the upper extremity DVT. We offered injections and rectal administration of blood thinners, however, you did not like those options. We discussed the risk and benefits of this decision. Transitional Issues Please follow-up with your appointments as listed. Please contact ___ for any issues with the IV medications - ___. Please continue IV Doxycycline until you see the infectious disease specialist.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Gabapentin 600 mg PO TID 2. ClonazePAM 2 mg PO BID:PRN Anxiety 3. Claritin-D 24 Hour (loratadine-pseudoephedrine) ___ mg oral DAILY 4. Mucinex DM (dextromethorphan-guaifenesin) ___ mg oral Q6H:PRN Congestion 5. Multivitamins 1 TAB PO DAILY 6. Lisinopril 5 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Primary: Syncope Hypertensive Urgency Secondary: Generalized Anxiety Disorder Bipolar Disorder Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to the hospital after an episode of losing consciousness (syncope). We performed numerous tests and determined your syncope is not related to a problem with your heart. We believe your syncope is likely due to a common condition known as vasovagal, where your body reacts suddenly to changes and stressors, causing you to briefly lose consciousness. You were provided with a heart monitor and instructed on its use. This is to be absolutely sure there is not any cause related to the heart. Because your blood pressure was high you were started on a new blood pressure medication. It was a pleasure taking care of you, -Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin EC 81 mg PO DAILY 2. Atorvastatin 40 mg PO DAILY 3. Calcium Carbonate 1500 mg PO DAILY 4. Cyanocobalamin 1000 mcg PO DAILY 5. Levothyroxine Sodium 300 mcg PO DAILY 6. Acetaminophen 650 mg PO Q4H:PRN fever, pain 7. Carvedilol 12.5 mg PO BID 8. Docusate Sodium 100 mg PO BID 9. TraMADOL (Ultram) 50 mg PO Q4H:PRN pain 10. alpha lipoic acid *NF* 50 mg Oral daily 11. Ascorbic Acid ___ mg PO DAILY 12. Fish Oil (Omega 3) ___ mg PO DAILY 13. garlic *NF* 1,000 mg Oral daily 14. Vitamin D ___ UNIT PO DAILY 15. Testim *NF* (testosterone) 50 mg/5 gram (1 %) Transdermal daily 16. Vitamin E 100 UNIT PO DAILY 17. Glargine 33 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 18. Clopidogrel 75 mg PO DAILY 19. Heparin 5000 UNIT SC TID 20. Milk of Magnesia 30 ml PO DAILY 21. ertapenem *NF* 1 gram Intravenous 24hrs Reason for Ordering: per ID 22. Heparin Flush (10 units/ml) 1 mL IV PRN line flush 23. ertapenem *NF* 1 gram Intravenous x1 stat Reason for Ordering: per ID 24. Potassium Chloride 20 mEq PO BID 25. Ranitidine 150 mg PO DAILY 26. Vancomycin 1000 mg IV Q 12H 27. Furosemide 40 mg PO QPM 28. Furosemide 80 mg PO DAILY 29. Isosorbide Mononitrate (Extended Release) 60 mg PO DAILY 30. Levothyroxine Sodium 25 mcg PO EVERY OTHER DAY 31. Sodium Chloride 0.9% Flush 3 mL IV Q8H:PRN line flush 32. Amlodipine 5 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Aortic stenosis Coronary Artery Disease, prior CABG ___ Dyslipidemia Hypertension Carotid artery disease, History of Left CEA Pheripheral vascular disease, s/p Bilateral iliac artery stenting Insulin Dependent Diabetes (nephropathy, neuropathy, retinopathy) Chronic Kidney Disease Discharge Condition: Alert and oriented x3 nonfocal Deconditioned-non weightbearing right foot Incisional pain managed with Incisions: Sternal - healing well, no erythema or drainage Leg: Left - healing well, no erythema or drainage. Edema: trace bilat Followup Instructions: ___ [/INST] </s><s>Please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. Look at your incisions daily for redness or drainage Please NO lotions, cream, powder, or ointments to incisions Each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart No driving for one month or while taking narcotics. driving will be discussed at follow up appointment with surgeon. No lifting more than 10 pounds for 10 weeks Please call with any questions or concerns ___ **Please call cardiac surgery office with any questions or concerns ___. Answering service will contact on call person during off hours**</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Nitrofurantoin Monohyd (MacroBID) 100 mg PO Q12H Duration: 4 Days RX *nitrofurantoin monohyd/m-cryst 100 mg 1 capsule(s) by mouth twice per day Disp #*8 Capsule Refills:*0 2. Aspirin 162 mg PO DAILY 3. Atorvastatin 20 mg PO QPM 4. Cilostazol 100 mg PO BID 5. Ciprofloxacin 0.3% Ophth Soln 1 DROP RIGHT EYE BID 6. Combigan (brimonidine-timolol) 0.2-0.5 % ophthalmic (eye) BID 7. Erythromycin 0.5% Ophth Oint 0.5 in RIGHT EYE DAILY 8. Lumigan (bimatoprost) 0.01 % OD QHS 9. Metoprolol Tartrate 12.5 mg PO DAILY 10. netarsudil 0.02 % ophthalmic (eye) QHS 11. Pantoprazole 40 mg PO Q24H 12. Tamsulosin 0.4 mg PO QHS 13. ValACYclovir 1000 mg PO Q12H Discharge Disposition: Home With Service Facility: ___. Discharge Diagnosis: Urinary tract infection Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure to care for you while you were hospitalized. You were admitted to the hospital due to weakness and increased urinary frequency. You were found to have a urinary tract infection. You improved with treatment with IV antibiotics and are now ready for discharge. Following discharge, you will require another 4 days of antibiotics. Please complete the course as prescribed. Please follow up with Dr. ___ as planned next week. Take care, Your BI Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Timolol Maleate 0.5% 1 DROP BOTH EYES DAILY 2. OLANZapine (Disintegrating Tablet) 5 mg PO BID:PRN agitation RX *olanzapine 5 mg 1 tablet(s) by mouth twice daily Disp #*10 Tablet Refills:*0 3. OLANZapine (Disintegrating Tablet) 10 mg PO QHS RX *olanzapine 10 mg 1 tablet(s) by mouth bedtime Disp #*5 Tablet Refills:*0 4. Lorazepam 0.5-1 mg SL Q4H:PRN seizure/agitation Please note this medication is very sedating for the patient. 5. Bisacodyl 10 mg PR QHS:PRN constipation 6. Morphine Sulfate (Concentrated Oral Soln) ___ mg PO Q2H:PRN pain/shortness of breath 7. Acetaminophen 650 mg PR Q6H:PRN pain Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Acute Encephalopathy secondary to UTI Glioblastoma Dementia Malnutrition ___ Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Lethargic but arousable. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the hospital for altered mental status thought to be related to a UTI. You were treated with antibiotics with some improvement. We are discharging you to hospice to focus on improving your symptoms. Take care, and we wish you the best. Sincerely, Your oncology team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Allopurinol ___ mg PO DAILY 2. Docusate Sodium (Liquid) 100 mg PO DAILY:PRN constipation 3. Ferrous Sulfate 325 mg PO DAILY 4. FoLIC Acid 1 mg PO DAILY 5. Mirtazapine 7.5 mg PO HS 6. Multivitamins W/minerals 1 TAB PO DAILY 7. QUEtiapine Fumarate 12.5 mg PO BID:PRN agitation 8. Senna 1 TAB PO BID 9. Acetaminophen 650 mg PO QHS 10. Finasteride 5 mg PO DAILY 11. Pantoprazole 40 mg PO Q24H 12. Cyanocobalamin ___ mcg PO DAILY Duration: 2 Weeks 13. Metoprolol Succinate ___ 25 mg PO HS Discharge Disposition: Expired Facility: ___ Discharge Diagnosis: Primary Diagnosis: Aspiration Pneumonia, Acute on Chronic Kidney Failure Secondary Diagnosis: Anemia, Diastolic Congestive Heart Failure, Vascular Dementia, Hypertension Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at the ___ ___. You were admitted to the hospital because you were found to be more confused and sleepy. You had imaging of your chest and were found to have a pneumonia which was treated with antibiotics and improved. You also had an injury to your kidney which appears to be improving. Please weigh yourself every morning, call MD if weight goes up more than 3 lbs. All the best, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Bisacodyl 10 mg PO/PR DAILY:PRN Constipation 2. Levothyroxine Sodium 75 mcg PO DAILY 3. Senna 1 TAB PO BID:PRN Constipation 4. Docusate Sodium (Liquid) 100 mg PO BID 5. Acetaminophen 650 mg PO Q6H 6. HYDROmorphone (Dilaudid) ___ mg PO Q3H:PRN pain RX *hydromorphone 1 mg/mL ___ Liquid(s) G tube Q3HRS Disp #*3 Bottle Refills:*0 7. OxycoDONE Liquid 10 mg PO Q4H:PRN pain RX *oxycodone 5 mg/5 mL 10 mL G tube Q4HRS Disp #*3 Bottle Refills:*0 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: 1. C1 fracture. 2. C2 fracture. 3. Occipital fracture. 4. Infiltrative lesion occiput, C1, C2. 5. Metastatic disease consistent with squamous cell carcinoma, tonsillar. 6. Neck pain. 7. Spinal cord stenosis. Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>You have undergone the following operation: Posterior Cervical Decompression and Fusion Immediately after the operation: -Activity: You should not lift anything greater than 10 lbs for 2 weeks. You will be more comfortable if you do not sit in a car or chair for more than ~45 minutes without getting up and walking around. -Rehabilitation/ Physical Therapy: o2-3 times a day you should go for a walk for ___ minutes as part of your recovery. You can walk as much as you can tolerate. oIsometric Extension Exercise in the collar: 2x/day x ___xercises as instructed. -Cervical Collar / Neck Brace: You need to wear the brace at all times until your follow-up appointment which should be in 2 weeks. You may remove the collar to take a shower. Limit your motion of your neck while the collar is off. Place the collar back on your neck immediately after the shower. -Wound Care: Remove the dressing in 2 days. If the incision is draining cover it with a new sterile dressing. If it is dry then you can leave the incision open to the air. Once the incision is completely dry (usually ___ days after the operation) you may take a shower. Do not soak the incision in a bath or pool. If the incision starts draining at anytime after surgery, do not get the incision wet. Call the office at that time. If you have an incision on your hip please follow the same instructions in terms of wound care. -You should resume taking your normal home medications. -You have also been given Additional Medications to control your pain. Please allow 72 hours for refill of narcotic prescriptions, so please plan ahead. You can either have them mailed to your home or pick them up at the clinic located on ___. We are not allowed to call in narcotic prescriptions (oxycontin, oxycodone, percocet) to the pharmacy. In addition, we are only allowed to write for pain medications for 90 days from the date of surgery. -Follow up: oPlease Call the office and make an appointment for 2 weeks after the day of your operation if this has not been done already. oAt the 2-week visit we will check your incision, take baseline x rays and answer any questions. oWe will then see you at 6 weeks from the day of the operation. At that time we will most likely obtain Flexion/Extension X-rays and often able to place you in a soft collar which you will wean out of over 1 week. Please call the office if you have a fever>101.5 degrees Fahrenheit, drainage from your wound, or have any questions. Physical Therapy: Activity: Activity: Activity as tolerated Cervical collar: At all times ___ Goals Time Frame: 1 week 1 - Indep state ___ spinal precautions 2 - CGA amb 100' c LRAD 3 - Tolerate high level balance test 4 - Indep supine to sit with HOB flat Treatments Frequency: Site: Posterior neck Description: surgical incision Care: asses SS of infection</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Levothyroxine Sodium 50 mcg PO DAILY 2. Lorazepam 0.5 mg PO HS:PRN insomnia 3. Sertraline 75 mg PO DAILY 4. Ciprofloxacin HCl 500 mg PO Q12H Continue this medication as prescribed until all of the pills are gone. RX *ciprofloxacin [Cipro] 500 mg 1 tablet(s) by mouth twice a day Disp #*20 Tablet Refills:*0 5. Timolol Maleate 0.5% 1 DROP BOTH EYES DAILY Discharge Disposition: Home Discharge Diagnosis: # Cholangitis with biliary obstruction (choledocolithiasis) # Pancreatic fullness; MRCP report pending # Weight loss/malnutrition, chronic loose stool # Acute GNR acute blood stream infection # New onset Atrial Fibrillation Secondary: # Depression # Hypothyroidism # Glaucoma Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>You were hospitalized with a blockage in your bile duct due to stones. The stones were removed by ERCP procedure. You also had an infection in your bile ducts which is being treated with antibiotics. It is very important that you complete the Ciprofloxacin prescription as prescribed.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: Patient left against medical advice and was advised to complete her prior Flagyl prescription and continue her outpatient meds noted on admission as prescribed by her physicians. Discharge Disposition: Home Discharge Diagnosis: Abdominal Pain Discharge Condition: Patient leaving against medical advice. Ambulatory Mental status clear and coherent Followup Instructions: ___ [/INST] </s><s>You acknowledge that you are leaving against medical advice. You were informed about an incidental 3mm lung nodule seen on your CT scan and the need to follow this finding up with your PCP to make sure that it is not cancerous (your risk is very low of cancer). You should not take opiate pain medication as this will worsen your gastric paresis, and risks intestinal perforation with concurrent C. difficile infection (which you report). Please complete your Metronidazole (Flagyl) course which you were prescribed by another physician. Please follow up with your PCP in person or at the very least by phone no later than tomorrow.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Propranolol 20 mg PO BID RX *propranolol 20 mg 1 tablet(s) by mouth twice a day Disp #*14 Tablet Refills:*0 2. Betamethasone Dipro 0.05% Oint 1 Appl TP BID 3. Calcium Carbonate 1000 mg PO DAILY 4. Cetirizine 10 mg PO DAILY 5. Cyanocobalamin 1000 mcg PO DAILY 6. Ferrous Sulfate 325 mg PO EVERY OTHER DAY 7. FoLIC Acid 1 mg PO DAILY 8. Furosemide 20 mg PO DAILY 9. Lactulose 30 mL PO TID 10. LevETIRAcetam 500 mg PO BID 11. Magnesium Oxide 800 mg PO QID 12. Mirtazapine 30 mg PO QHS 13. Multivitamins 1 TAB PO DAILY 14. Ranitidine 150 mg PO DAILY 15. Rifaximin 550 mg PO BID 16. Spironolactone 25 mg PO DAILY 17. Sucralfate 2 gm PO BID 18. Thiamine 100 mg PO DAILY 19. Vitamin D ___ UNIT PO 1X/WEEK (___) Discharge Disposition: Home Discharge Diagnosis: Hypomagnesemia Hypokalemia Hypophosphatemia Alcohol dependence with withdrawal History of seizures Cirrhosis with history of esophageal varices Elevated LFTs Neutropenia Pancytopenia Bipolar disorder Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr. ___, You were hospitalized with signs of alcohol withdrawal. You were treated with phenobarbital and this has been very helpful for managing your withdrawal. It is very important to avoid any further alcohol use. If you feel like you're going to drink alcohol again, please call your doctor ___. Alcohol use is causing multiple medical problems including electrolyte abnormalities, low blood counts, abnormal liver function tests. Please talk with your social workers as well and consider outpatient rehabilitation programs if possible. You were found to have multiple lab abnormalities including severely low magnesium, potassium and phosphorus. You were given IV and oral supplements of these and they have improved. I have recommended that your PCP's office recheck these labs at your visit on ___ to make sure they do not become too low again. It is important to stay well hydrated and eat regularly. Your liver function tests were elevated but an ultrasound showed no abnormalities (including no obstruction) in your liver or bile ducts. These tests are all improving, likely due to not drinking alcohol. I recommend having these rechecked as well. You have chronically low blood counts, which were very low on admission. You had a low white blood cell count and especially concerning, was a low neutrophil count. Fortunately your blood counts are improved since admission and again likely due to not drinking alcohol. Please have your blood counts checked again. If you have any signs of bleeding, it is critical to have your counts rechecked. It was a pleasure to take care of you here at ___ and we wish you good health and recovery.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. BuPROPion (Sustained Release) 100 mg PO QAM 2. Sertraline 50 mg PO DAILY 3. Acetaminophen-Caff-Butalbital ___ TAB PO Q8H:PRN headache 4. Docusate Sodium 100 mg PO BID:PRN constipation 5. OxycoDONE (Immediate Release) 2.5 mg PO Q4H:PRN pain Do not drive or combine with alcohol. RX *oxycodone 5 mg ___ tablet(s) by mouth every 4 hours Disp #*30 Tablet Refills:*0 6. Famotidine 20 mg PO BID 7. Acetaminophen 650 mg PO Q8H:PRN pain 8. Ondansetron 4 mg PO Q8H:PRN nausea Discharge Disposition: Home Discharge Diagnosis: Small bowel obstruction Ovarian cancer Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, . You were admitted to the gynecologic oncology service after presenting with a small bowel obstruction. While you were in the hospital we stopped your diet entirely to give your bowels rest and controlled your abdominal pain with pain medications. We then gradually advanced your diet. You have recovered well, and the team feels that you are safe to be discharged home. Please continue to self-regulate your diet and follow the recommendations provided to you by Nutrition for a low residue diet. . To reach medical records to get the records from this hospitalization sent to your doctor at home, call ___. . Call your doctor at ___ for: * fever > 100.4 * severe abdominal pain * nausea/vomiting where you are unable to keep down fluids/food or your medication * chest pain or difficulty breathing * onset of any concerning symptoms</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acyclovir 400 mg PO Q12H 2. amLODIPine 5 mg PO DAILY 3. Aspirin 325 mg PO DAILY 4. Ibuprofen 800 mg PO Q8H:PRN Pain - Mild 5. Lidocaine 5% Patch 1 PTCH TD QPM 6. OxyCODONE (Immediate Release) ___ mg PO Q6H:PRN Pain - Moderate 7. Senna 8.6 mg PO BID:PRN Constipation - First Line 8. Spironolactone 25 mg PO DAILY 9. Vitamin D 1000 UNIT PO DAILY 10. HELD- Dexamethasone 10 mg PO ASDIR This medication was held. Do not restart Dexamethasone until discussing with Dr. ___ 11. HELD- Pomalyst (pomalidomide) 2 mg oral DAILY This medication was held. Do not restart Pomalyst until discussing with Dr. ___ ___ Disposition: Home Discharge Diagnosis: #Meningoencephalitis NOS Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, Thank you for coming to ___ for your care. Please read the following directions carefully: WHY WAS I ADMITTED TO THE HOSPITAL? - You were admitted to the hospital because you had fevers and confusion while you were at home - We were concerned you had an infection that involves your brain and spinal cord. WHAT WAS DONE FOR ME WHILE I WAS HERE? - You had several tests including a spinal tap and an MRI. These unfortunately did not show exactly what bacteria or virus could be causing your symptoms - We gave you a course of antibiotics through an IV to treat several possible causes of these kinds of infections WHAT DO I NEED TO DO AFTER I LEAVE THE HOSPITAL? - The medications you were taking before you came to the hospital have not been changed. They are listed below as well - Please keep your appointments as listed below - If you develop new fevers, confusion, or any other concerning symptoms, please seek urgent medical attention We wish you the best with your health! - Your ___ care team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. AcetaZOLamide 500 mg PO Q12H 2. Docusate Sodium 100 mg PO BID:PRN constipation RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth daily Disp #*30 Capsule Refills:*0 3. Ondansetron 8 mg PO Q8H:PRN nausea RX *ondansetron HCl 8 mg 1 tablet(s) by mouth q8hrs Disp #*9 Tablet Refills:*0 4. ketorolac 10 mg oral q6hrs PRN headache RX *ketorolac 10 mg 1 tablet(s) by mouth q6hrs Disp #*8 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: 1. chiari malformation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear. Ms ___, You were admitted for evaluation of your headache. It was different from your previous headaches associated with pseudotumor, was bad throughout the day (regardless of cough/laugh) and was associated with neck pain, upper back numbness, and right more than left hand numbness. After thorough evaluation, we feel that your headache may now be primarily secondary to you Chiari malformation. We performed a cervical spine MRI during your stay to make sure your symptoms were not from spinal compression from any other etiology - this exam was remarkable only for your low lying cerebellar tonsils consistent with Chiari malformation. You will follow up with Neurosurgery for further Chiari evaluation, MRI CSF CINE flow study, and for discussion of neurosurgical evaluation.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 2. Docusate Sodium 100 mg PO BID 3. LevETIRAcetam 500 mg PO BID Duration: 7 Days RX *levetiracetam 500 mg 1 tablet(s) by mouth every 12 hours Disp #*9 Tablet Refills:*0 4. Alendronate Sodium 35 mg PO WEEKLY 5. amLODIPine 5 mg PO DAILY 6. Ciprofloxacin HCl 500 mg PO/NG Q12H Duration: 2 Days Continue through ___ then stop as previously prescribed 7. ___ mg/mL ophthalmic BID 8. HydrALAZINE 50 mg PO BID 9. LaMIVudine 50 mg PO DAILY 10. Metoprolol Succinate XL 12.5 mg PO DAILY 11. Mycophenolate Mofetil 500 mg PO BID 12. Sodium Bicarbonate 650 mg PO BID 13. Sulfameth/Trimethoprim SS 1 TAB PO DAILY 14. Tacrolimus 2 mg PO Q12H 15. Vitamin D ___ UNIT PO 1X/WEEK (___) Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: subdural hematoma atrial fibrillation h/o kidney transplant UTI Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Discharge Instructions Brain Hemorrhage without Surgery Activity · We recommend that you avoid heavy lifting, running, climbing, or other strenuous exercise until your ___ appointment. · You make take leisurely walks and slowly increase your activity at your own pace once you are symptom free at rest. ___ try to do too much all at once. · No driving while taking any narcotic or sedating medication. · If you experienced a seizure while admitted, you are NOT allowed to drive by law. · No contact sports until cleared by your neurosurgeon. You should avoid contact sports for 6 months. Medications · ***Please do NOT take any blood thinning medication (Aspirin, Ibuprofen, Plavix, Coumadin) until cleared by the neurosurgeon. You should hold Eliquis until follow up with neurosurgery in 1 month with a repeat head CT. · ***You have been discharged on Keppra (Levetiracetam). This medication helps to prevent seizures. Please continue this medication for a through ___, then stop. It is important that you take this medication consistently and on time. · You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. What You ___ Experience: · You may have difficulty paying attention, concentrating, and remembering new information. · Emotional and/or behavioral difficulties are common. · Feeling more tired, restlessness, irritability, and mood swings are also common. · Constipation is common. Be sure to drink plenty of fluids and eat a ___ diet. If you are taking narcotics (prescription pain medications), try an ___ stool softener. Headaches: · Headache is one of the most common symptom after a brain bleed. · Most headaches are not dangerous but you should call your doctor if the headache gets worse, develop arm or leg weakness, increased sleepiness, and/or have nausea or vomiting with a headache. · Mild pain medications may be helpful with these headaches but avoid taking pain medications on a daily basis unless prescribed by your doctor. · There are other things that can be done to help with your headaches: avoid caffeine, get enough sleep, daily exercise, relaxation/ meditation, massage, acupuncture, heat or ice packs. When to Call Your Doctor at ___ for: · Severe pain, swelling, redness or drainage from the incision site. · Fever greater than 101.5 degrees Fahrenheit · Nausea and/or vomiting · Extreme sleepiness and not being able to stay awake · Severe headaches not relieved by pain relievers · Seizures · Any new problems with your vision or ability to speak · Weakness or changes in sensation in your face, arms, or leg Call ___ and go to the nearest Emergency Room if you experience any of the following: · Sudden numbness or weakness in the face, arm, or leg · Sudden confusion or trouble speaking or understanding · Sudden trouble walking, dizziness, or loss of balance or coordination · Sudden severe headaches with no known reason</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 5 mg PO BID hold for SBP < 105 2. Clonazepam ___ mg PO BID:PRN anxiety hold pls if sedated or RR < 10 RX *clonazepam 1 mg ___ tablet(s) by mouth twice per day Disp #*5 Tablet Refills:*0 3. Kaletra 2 TAB PO BID 4. Truvada 1 TAB PO DAILY 5. Acetaminophen 325-650 mg PO Q6H:PRN pain, fever 6. Albuterol 0.083% Neb Soln 1 NEB IH Q2H:PRN wheezing 7. Bisacodyl 10 mg PO/PR DAILY:PRN constipat 8. CefePIME 1 g IV Q12H continue through ___ 9. Docusate Sodium 100 mg PO BID 10. Heparin 7500 UNIT SC TID 11. Heparin Flush (10 units/ml) 2 mL IV PRN line flush PICC, heparin dependent: Flush with 10mL Normal Saline followed by Heparin as above daily and PRN per lumen. 12. Ipratropium Bromide Neb 1 NEB IH Q6H 13. Methadone 90 mg PO DAILY hold for sedation, RR<10 RX *methadone 10 mg 9 tabs by mouth daily Disp #*18 Tablet Refills:*0 14. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H continue through ___ 15. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN pain HOLD for sedation, RR<12, confusion RX *oxycodone 5 mg ___ tablet(s) by mouth every 6 hours Disp #*15 Tablet Refills:*0 16. Polyethylene Glycol 17 g PO DAILY 17. Senna 1 TAB PO BID:PRN constipation 18. Sodium Chloride 0.9% Flush 10 mL IV PRN line flush PICC, non-heparin dependent: Flush with 10 mL Normal Saline daily and PRN per lumen. 19. Beclomethasone Dipro. AQ (Nasal) *NF* 42 mcg Other TID 20. Loratadine *NF* 10 mg Oral daily 21. Vitamin D 1000 UNIT PO DAILY 22. Outpatient Lab Work Diagnosis: empyema CBC with differential (weekly) (x) Chem 7 (weekly) (x) BUN/Cr (weekly) (x) AST/ALT (weekly) (x) Alk Phos (weekly) (x) Total bili (weekly) (x) ESR/CRP (weekly) (x) All laboratory results should be faxed to the ___ R.N.s at ___. All questions regarding outpatient parenteral antibiotics should be directed to the ___ ___ R.N.s at ___ or to the on-call ID fellow when the clinic is closed. Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Empyema Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted with pneumonia and infected fluid in your lung. You had this drained with a chest tube and you were started on antibiotics. Based on the results of type of bacteria, you will require 4 weeks of intravenous antibiotics. You will need to follow up with infectious disease doctors to make sure you continue to have improvement. You were found to be slightly weak from your long hospitalization. You were discharged to rehab so you could get your antibiotics and improve your strength.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY RX *aspirin [Aspir-81] 81 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 2. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 3. FoLIC Acid 1 mg PO DAILY RX *folic acid 1 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 4. Furosemide 20 mg PO BID RX *furosemide 20 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 5. Midodrine 10 mg PO BID Take at 8 AM and 2PM RX *midodrine 10 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 6. Multivitamins 1 TAB PO DAILY RX *multivitamin 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 7. Sodium Chloride Nasal ___ SPRY NU QID:PRN epistaxis, nasal dryness RX *sodium chloride [Saline Nasal] 0.65 % ___ spray intra nasal BID:PRN Disp #*1 Bottle Refills:*0 8. Spironolactone 50 mg PO BID RX *spironolactone 50 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 9. Thiamine 100 mg PO DAILY RX *thiamine HCl (vitamin B1) 100 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 10.Outpatient Lab Work Please check CBC, Chem10, LFTs on ___ and fax to 1) ___ Attn. Dr. ___ 2) ___ Attn. Dr. ___ 11.Durable Medical Equipment Rolling Walker orthostatic hypotension. ICD 10: I95.1. Duration: 13 months Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary diagnosis: decompensated cirrhosis, alcohol-induced Secondary diagnosis: chronic systolic heart failure, orthostatic hypotension, protein energy malnutrition Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, ================================ WHY DID YOU COME TO THE HOSPITAL? ================================ - For evaluation of swelling in your legs and abdomen ===================================== WHAT WAS DONE FOR YOU DURING YOUR STAY? ===================================== - You were diagnosed with cirrhosis of the liver, which in your case is related to alcohol use. This led to the fluid build up in your belly. - It was found that your heart does not pump as strong as it should (called heart failure), which also led to the fluid building up. - The extra fluid was removed by giving you medications to increase urination ("water pills"/"diuretics") and by draining the fluid directly from your belly with a needle ("paracentesis") twice - A scope was done of the tube leading to your gut (esophagus) using a camera ("EGD") and did NOT see any large veins ("varices") that were at risk of bleeding. - A nutritionist developed a high protein-low salt meal plan to help rebuild muscle mass and keep the fluid off. ============================================== WHAT NEEDS TO HAPPEN WHEN YOU LEAVE THE HOSPITAL? ============================================== - Stop drinking alcohol completely, even 1 drink is too many. - Take all the medications as prescribed (see below) - Follow up on ___ with your primary care physician's office - Follow up in liver clinic with Dr. ___ as below - Follow up in cardiology clinic (see below) - Weigh yourself everyday and let you primary doctor know if your weight goes up by more than 3 pounds in 2 days. - Make sure to drink an Ensure with breakfast, lunch, and dinner everyday. - Eat no more than 2g of salt every day - Use the rolling walker to get around and if you ever feel dizzy or lightheaded, seek medical attention immediately It was a pleasure taking care of you during your stay! Sincerely, Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours). 2. enoxaparin 40 mg/0.4 mL Syringe Sig: One (1) syringe Subcutaneous Q24H (every 24 hours). Disp:*14 syringe* Refills:*0* 3. bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for Constipation. 4. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 5. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 6. multivitamin Tablet Sig: One (1) Cap PO DAILY (Daily). 7. oxycodone 5 mg Tablet Sig: ___ Tablets PO Q3h as needed for Pain. Disp:*60 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Right Ankle trimalleolar fracture dislocation. Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>******SIGNS OF INFECTION********** Please return to the emergency department or notify MD if you should experience severe pain, increased swelling, decreased sensation, difficulty with movement; fevers >101.5, chills, redness or drainage at the incision site; chest pain, shortness of breath or any other concerns. Wound Care: You can get the wound wet/take a shower starting from 3 days post-op. Always remove your bivalve cast when taking a shower, do not get it wet. You may continue dry sterile dressings with ABD pad to the wound, and wrap with kerlix or ace wrap. No baths or swimming for at least 4 weeks. Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. No dressing is needed if wound continued to be non-draining. ******WEIGHT-BEARING******* Right lower extremity: Non-weight bearing in splint ******MEDICATIONS*********** - Resume your pre-hospital medications. - You have been given medication for your pain control. Please do not operate heavy machinery or drink alcohol when taking this medication. As your pain improves please decrease the amount of pain medication. This medication can cause constipation, so you should drink ___ glasses of water daily and take a stool softener (colace) to prevent this side effect. -Medication refills cannot be written after 12 noon on ___. *****ANTICOAGULATION****** - Take Lovenox for DVT prophylaxis for 2 weeks post-operatively. ******FOLLOW-UP********** Please follow up with ___ in ___ days post-operation for evaluation and staple/suture removal. Call ___ to schedule appointment upon discharge. Please follow up with your PCP regarding this admission and any new medications/refills.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you during your hospitalization at ___. You were admitted after becoming ill at your home. On arrival to the hospital you were found to be very dehydrated with a very high blood sugar. Because of this you were initially admitted to the medical intensive care unit. You improved and were moved to regular medical floor. To continue to regain your strength you will now be discharged to a rehab facility. We wish you luck in your continued recovery!</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ursodiol 500 mg PO BID RX *ursodiol 500 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 2. Acetaminophen 500 mg PO Q6H:PRN Pain - Mild 3. Cyclobenzaprine 5 mg PO QHS PRN back pain 4. Glargine 50 Units Dinner novolog 12 Units Breakfast novolog 12 Units Lunch novolog 12 Units DinnerMax Dose Override Reason: per ___ recs RX *insulin glargine [Lantus U-100 Insulin] 100 unit/mL 0.5 (One half) ml subcutaneously nightly Disp #*1 Vial Refills:*0 RX *insulin admin supplies [InPen (for Novolog)] AS DIR 12 Units before breakfast; 12 Units before lunch; 12 Units before dinner Disp #*1 Syringe Refills:*0 5. Sumatriptan Succinate 50 mg PO DAILY:PRN migraine 6. Amitriptyline 100 mg PO QHS 7. Citalopram 20 mg PO DAILY 8. Ibuprofen 400 mg PO Q8H:PRN Pain - Moderate Discharge Disposition: Home Discharge Diagnosis: #Primary Cholelithiasis #Secondary: Cirrhosis, unclear etiology Diabetes mellitus type II, insulin dependent Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you at ___ ___! Why you were admitted to the hospital: - You were having abdominal pain, particularly with eating - You were diagnosed with gallstones, which are likely causing your pain What happened while you were here: - Surgery was deferred due to a high risk of complications - You were treated medically and your pain slowly improved - Additionally, work up showed that you have cirrhosis, which is scarring of the liver - Several tests were sent to find out the cause of the scarring, many of which were still pending at discharge What you should do once you return home: - Please continue taking your medications as prescribed - Please follow up with the appointments outlined below. Specifically, you should see your primary care provider, ___ liver doctor, and the diabetes doctor - If you do not wish to attend the ___ appointment, please call your endocrinologist to schedule an appointment within ___ weeks - You should decrease the dose of the cyclobenzaprine and sumatriptan given the new diagnosis of cirrhosis We wish you the best. Sincerely, Your ___ Care team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Apixaban 5 mg PO BID 2. HYDROcodone-acetaminophen 7.5-300 mg oral PRN Pain 3. Metoprolol Succinate XL 25 mg PO BID 4. Flecainide Acetate 50 mg PO Q12H 5. Vitamin D ___ UNIT PO WEEKLY 6. Zolpidem Tartrate 5 mg PO QHS:PRN sleep aid Discharge Disposition: Home Discharge Diagnosis: Thyroiditis Atrial Fibrillation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to ___ for a recurrence of atrial fibrillation and hyperthyroidism related to thyroiditis as shown by thyroid scan. Continue all of your medications with the following changes: - Start Apixaban (Eliquis) 5mg twice a day. This medication is a blood thinner that prevents blood clots from forming in your heart due to atrial fibrillation. - Stop aspirin and levothyroxine. - Increase Metoprolol Succinate to 25mg twice a day. This is to keep your heart rate under control. You did not have a cardioversion to get you back in a normal heart rhythm because the Electrophysiology doctors ___ your ___ function back to normal prior to attempting a cardioversion. If you have any urgent questions that are related to your recovery from your medical issues or are experiencing any symptoms that are concerning to you and you think you may need to return to the hospital, please call the ___ HeartLine at ___ to speak to a cardiologist or cardiac nurse practitioner. It has been a pleasure to have participated in your care and we wish you the best with your health! Your ___ Cardiac Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 10 mg PO DAILY 2. Lisinopril 40 mg PO DAILY 3. OLANZapine 5 mg PO DAILY 4. Warfarin 2.5 mg PO DAILY16 5. Aspirin 81 mg PO DAILY 6. Dorzolamide 2%/Timolol 0.5% Ophth. 1 DROP LEFT EYE BID 7. Erythromycin 0.5% Ophth Oint 0.5 in RIGHT EYE TID 8. MetFORMIN XR (Glucophage XR) 1000 mg PO DAILY 9. Metoprolol Succinate XL 100 mg PO DAILY 10. Simvastatin 20 mg PO DAILY 11. Fluoxetine 40 mg PO DAILY 12. LaMOTrigine 100 mg PO DAILY 13. Furosemide 40 mg PO DAILY 14. Outpatient Lab Work Check INR and Chem 10 on ___. ICD-9: 428.0 Congestive heart failure Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: PRIMARY DIAGNOSES: Healthcare Associated Pneumonia Altered mental status SECONDARY DIAGNOSES: Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Mr. ___, It was a pleasure taking care of you at the ___ ___ ___. You were admitted for pneumonia and because you were not behaving as your usual self. You were treated with antibiotics and your pneumonia resolved. You received a lot of fluids while in the hospital which caused fluid build up in and around your lungs. We treated this with medication which made you urinate all the excess fluid. Please continue to take all your medication as prescribed. Weigh yourself every morning, if weight goes up more than 3 lbs please increase your lasix from 40mg once a day to 40mg every 12 hours (twice a day).</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr. ___, It was a pleasure taking part in your care during your admission to ___. As you know, you were admitted for chest pain. A study of the blood vessels that supply your heart (cardiac catheterization) showed stable blockages of a few vessels, and no intervention was felt to be necessary. Though it is clear that you did not suffer a heart attack, it is less clear what might have caused your chest pain. However, if you have severe pain again, you should immediately return to the emergency department for evaluation. No changes were made to your medications.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain do not drive or drink alcohol while taking this 2. Insulin Pump SC (Self Administering Medication) Basal Rates: Midnight - 4A: 1.75 Units/Hr 4A - 10A: 1.5 Units/Hr 10A - midnight: 1.3 Units/Hr Meal Bolus Rates: Breakfast = 1:5 Lunch = 1:5 Dinner = 1:5 Snacks = 1:5 MD acknowledges patient competent MD has ordered ___ consult MD has completed competency 3. Acetaminophen 650 mg PO Q6H:PRN pain 4. Docusate Sodium 100 mg PO BID Discharge Disposition: Home Discharge Diagnosis: Acute appendicitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital with right lower quadrant pain and were found to have acute appendicitis. You were taken to the operating room and had your appendix removed laparoscopically. You tolerated the procedure well and are now being discharged home to continue your recovery with the following instructions. Please follow up in the Acute Care Surgery clinic at the appointment listed below. ACTIVITY: o Do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. o You may climb stairs. o You may go outside, but avoid traveling long distances until you see your surgeon at your next visit. o Don't lift more than ___ lbs for 4 weeks. (This is about the weight of a briefcase or a bag of groceries.) This applies to lifting children, but they may sit on your lap. o You may start some light exercise when you feel comfortable. o You will need to stay out of bathtubs or swimming pools for a time while your incision is healing. Ask your doctor when you can resume tub baths or swimming. HOW YOU MAY FEEL: o You may feel weak or "washed out" for a couple of weeks. You might want to nap often. Simple tasks may exhaust you. o You may have a sore throat because of a tube that was in your throat during surgery. o You might have trouble concentrating or difficulty sleeping. You might feel somewhat depressed. o You could have a poor appetite for a while. Food may seem unappealing. o All of these feelings and reactions are normal and should go away in a short time. If they do not, tell your surgeon. YOUR INCISION: o Tomorrow you may shower and remove the gauzes over your incisions. Under these dressing you have small plastic bandages called steri-strips. Do not remove steri-strips for 2 weeks. (These are the thin paper strips that might be on your incision.) But if they fall off before that that's okay). o Your incisions may be slightly red around the stitches. This is normal. o You may gently wash away dried material around your incision. o Avoid direct sun exposure to the incision area. o Do not use any ointments on the incision unless you were told otherwise. o You may see a small amount of clear or light red fluid staining your dressing or clothes. If the staining is severe, please call your surgeon. o You may shower. As noted above, ask your doctor when you may resume tub baths or swimming. YOUR BOWELS: o Constipation is a common side effect of narcotic pain medications. If needed, you may take a stool softener (such as Colace, one capsule) or gentle laxative (such as milk of magnesia, 1 tbs) twice a day. You can get both of these medicines without a prescription. o If you go 48 hours without a bowel movement, or have pain moving the bowels, call your surgeon. PAIN MANAGEMENT: o It is normal to feel some discomfort/pain following abdominal surgery. This pain is often described as "soreness". o Your pain should get better day by day. If you find the pain is getting worse instead of better, please contact your surgeon. o You will receive a prescription for pain medicine to take by mouth. It is important to take this medicine as directed. o Do not take it more frequently than prescribed. Do not take more medicine at one time than prescribed. o Your pain medicine will work better if you take it before your pain gets too severe. o Talk with your surgeon about how long you will need to take prescription pain medicine. Please don't take any other pain medicine, including non-prescription pain medicine, unless your surgeon has said its okay. o If you are experiencing no pain, it is okay to skip a dose of pain medicine. o Remember to use your "cough pillow" for splinting when you cough or when you are doing your deep breathing exercises. If you experience any of the following, please contact your surgeon: - sharp pain or any severe pain that lasts several hours - pain that is getting worse over time - pain accompanied by fever of more than 101 - a drastic change in nature or quality of your pain MEDICATIONS: Take all the medicines you were on before the operation just as you did before, unless you have been told differently. If you have any questions about what medicine to take or not to take, please call your surgeon.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 500 mg PO Q6H:PRN pain 2. Aspirin 325 mg PO DAILY 3. Calcitriol 0.25 mcg PO DAILY 4. Clopidogrel 75 mg PO DAILY 5. Labetalol 300 mg PO TID RX *labetalol 300 mg 1 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*0 6. Mirtazapine 15 mg PO HS 7. Nitroglycerin SL 0.4 mg SL Q5MIN:PRN chest pain 8. Simvastatin 40 mg PO DAILY 9. TraMADOL (Ultram) 50 mg PO Q8H:PRN pain 10. fenofibrate 54 mg oral daily 11. FiberCon (calcium polycarbophil) 625 mg oral BID 12. Loratadine 10 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: - Atypical chest pain Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you during your admission to ___ ___. As you know, you came in with chest pain. Your EKG and blood tests did not show evidence of a heart attack and your pain improved. During your stay, your blood pressure was very high, and we increased your labetolol to three times per day. We did not make any other changes to your medications. Please call your doctor right away if you feel lightheaded or dizzy, or if you have chest pain or a racing heart beat again. Please weigh yourself every morning and call your doctor if weight goes up more than 3 lbs. Once again, it was a pleasure caring for you and we wish you the best, Sincerely, Your Medical Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO QHS 2. Gabapentin 300 mg PO QHS 3. Omeprazole 20 mg PO DAILY 4. Oxcarbazepine 1200 mg PO QAM 5. glimepiride 2 mg ORAL BID 6. Invokana (canagliflozin) 300 mg oral DAILY 7. liraglutide 1.8 mg subcutaneous DAILY 8. Lisinopril 20 mg PO DAILY 9. MetFORMIN (Glucophage) 1000 mg PO BID 10. MetFORMIN (Glucophage) 500 mg PO LUNCH 11. Meclizine 12.5 mg PO TID RX *meclizine 12.5 mg 1 tablet(s) by mouth three times a day Disp #*21 Tablet Refills:*0 12. Outpatient Physical Therapy Vestibular Outpatient Rehab for Left Peripheral Hypofunction Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: # Benign Positional Paroxysmal Vertigo # Viral Gastroenteritis / Abdominal Pain / Nausea # Type 2 Diabetes with neurologic complications # Bipolar disorder # Hyperlipidemia # GERD # Hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>It was a pleasure caring for you at ___. You were admitted with nausea and vomiting. You underwent testing that did not show signs of a serious infection. Your symptoms improved--you most likely had a "stomach bug" (viral gastroenteritis). While you were here, you were also dizzy. This is likely the result of a condition called "benign paroxysmal positional vertigo". This may be a result of your recent viral infection. It should resolve over time--in the meantime, we recommended using a medication called meclizine to treat your symptoms. You were seen by a physical therapist who recommended that you continue to see a physical therapist to help you with these symptoms. You have improved and are now ready for discharge</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Device Type of equipment: Rolling walker Reason: gait training Length of need: Lifetime Diagnosis: post-viral syndrome prognosis: good 2. Lorazepam 0.5 mg PO BID:PRN anxiety 3. Pantoprazole 40 mg PO Q12H 4. Rosuvastatin Calcium 10 mg PO QOD 5. ___ (cranberry extract) 3000 mg oral daily 6. Viactiv (calcium-vitamin D3-vitamin K) 500-500-40 mg-unit-mcg oral BID 7. Hydrochlorothiazide 25 mg PO DAILY RX *hydrochlorothiazide 25 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 8. Lisinopril 5 mg PO DAILY RX *lisinopril 5 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Recent viral gastroenteritis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>You were admitted with difficulty walking. You were seen by physical therapy and they recommended a rolling walker and continued physical therapy at home. MRI of the brain showed several very tiny "specks" that the radiologist thought could be old tiny strokes, but nothing new or "acute" that would explain your recent symptoms.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amiodarone 200 mg PO DAILY RX *amiodarone 200 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 2. Rosuvastatin Calcium 20 mg PO QPM RX *rosuvastatin 20 mg 1 tablet(s) by mouth qPM Disp #*30 Tablet Refills:*0 3. Torsemide 40 mg PO BID RX *torsemide 20 mg 2 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 4. Insulin SC Sliding Scale Fingerstick QACHS, HS Insulin SC Sliding Scale using HUM Insulin 5. Warfarin 7.5 mg PO DAILY16 RX *warfarin 2.5 mg 3 tablet(s) by mouth qday Disp #*30 Tablet Refills:*0 6. Aspirin 81 mg PO DAILY 7. Calcium Carbonate 1250 mg PO TID W/MEALS 8. Cyanocobalamin 1000 mcg IM/SC QMONTH 9. Docusate Sodium 100 mg PO DAILY 10. Fish Oil (Omega 3) 1000 mg PO BID 11. Pantoprazole 40 mg PO Q24H 12. sevelamer CARBONATE 800 mg PO TID W/MEALS 13.Outpatient Lab Work Draw labs on ___ Indication: Heart failure (ICD-9-CM 428.00) Labs to draw: Chem-10 panel Fax results to: Dr. ___ (F: ___ and Dr. ___ ___ (F: ___ Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: Acutely Decompensated Heart Failure with preserved Ejection Fraction Atrial fibrillation Acute on chronic kidney disease SECONDARY DIAGNOSIS Coronary artery disease Diabetes Discharge Condition: Level of Consciousness: Alert and interactive. Mental Status: Clear and coherent. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure to be part of your care at ___. You were admitted to the hospital because you were having difficulty breathing and were having leg swelling, which were concerning for a heart failure exacerbation. This heart failure exacerbation was likely exacerbated by an episode of atrial fibrillation. You were treated with diuretics to help get rid of the extra fluid that you had accumulated as a result of your heart failure and with a medicine to help your heart beat more efficiently. In the hospital you received a cardioversion to help return your heart back to a normal rhythm. Your home beta-blocker (carvedilol) was stopped. You were not re-started on a beta-blocker because your blood pressure was low. Your heart remained in a normal rhythm for most of your stay, however at the end it converted back to an irregular rhythm. You underwent a second cardioversion on ___. Your diuretic Lasix was switched to torsemide 40 mg, which you should take twice a day. If you experience any worsening difficulty breathing or accumulation of swelling in your legs, please contact your doctor. Please monitor your INR daily and call the result in to your PCP, ___ (___). We wish you the best, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Calcium Carbonate 500 mg PO QID:PRN indigestion 2. Famotidine 20 mg PO BID 3. Ipratropium-Albuterol Neb 1 NEB NEB Q6H:PRN shortness of breath 4. Lisinopril 2.5 mg PO DAILY 5. macitentan 10 mg oral daily 6. Magnesium Oxide 400 mg PO BID 7. Omeprazole 20 mg PO DAILY 8. sildenafil 20 mg oral TID 9. Vitamin D 1000 UNIT PO DAILY 10. Warfarin 2.5 mg PO 4X/WEEK (___) 11. Torsemide 20 mg PO DAILY RX *torsemide [Demadex] 20 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 12. Warfarin 2.5 mg PO DAILY16 13. Acetaminophen 325 mg PO Q6H:PRN pain 14. Metoprolol Succinate XL 25 mg PO DAILY RX *metoprolol succinate 25 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: Heart failure exacerbation Secondary: Chronic obstructive pulmonary disease Obstructive sleep apnea Atrial fibrillation, anticoagulated for at least last ___ years Hypertension Hyperlipidemia Gout Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory with assist. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It has been a pleasure taking part in your care during your hospitalization. You were admitted to ___ ___ for an exacerbation of heart failure, with weight gain and swelling despite an increase of your dose of lasix. Please continue to take your home medications. Please follow up with the appointments as described below. Weigh yourself every morning, call your doctor if your weight goes up more than 3 lbs in one day or more than 5 lbs in one week. Again, it has been a pleasure taking part in your care and we wish you the best.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN Pain-Mild/Fever >100 2. Bacitracin Ointment 1 Appl TP QID 3. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg ONE capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 4. Phenazopyridine 100 mg PO Q8H:PRN dysuria/urgency Duration: 3 Days RX *phenazopyridine 100 mg ONE tablet(s) by mouth Q8hrs Disp #*9 Tablet Refills:*0 5. Senna 17.2 mg PO QHS 6. Acyclovir 400 mg PO 5X/D ___ flare 7. Finasteride 5 mg PO DAILY 8. Losartan Potassium 50 mg PO QHS 9. Tamsulosin 0.4 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Hematuria, gross retention, clot urinary Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>These steps can help you recover after your procedure. •DO drink plenty of water to flush out the bladder. •DO avoid straining during a bowel movement. Eat fiber-containing foods and avoid foods that can cause constipation. Ask your doctor if you should take a laxative if you do become constipated. •Don't take blood-thinning medications until your doctor says it's OK. •Don't do any strenuous activity, such as heavy lifting, for four to six weeks or until your doctor says it's OK. •Don't have sex. You'll likely be able to resume sexual activity in about four to six weeks. •Don't drive until your doctor says it's OK. ___, you can drive once your catheter is removed and you're no longer taking prescription pain medications. •You may continue to periodically see small amounts of blood in your urine--this is normal and will gradually improve. You may have clear or yellow urine that periodically turns pink/red throughout the healing process. Generally, the discoloration of the urine is “OK” unless it transitions from ___, ___ Aid to a very dark, thick or “like tomato juice” color •Resume your pre-admission/home medications EXCEPT as noted. You should ALWAYS call to inform, review and discuss any medication changes and your post-operative course with your primary care team. •Unless otherwise advised, blood thinning medications like ASPIRIN should be held until the urine has been clear/yellow for at least three days. Your medication reconciliation will note if you may resume aspirin or prescription blood thinners (like Coumadin (warfarin), Xarelto, Lovenox, etc.) •-an ointment like bacitracin/Neosporin or "triple antibiotic" ointment is recommended for comfort at urethral meatus where the foley catheter inserts. Apply the ointment for comfort ___ x daily if needed. •If needed, you will be prescribed an antibiotic to continue after discharge or save until your Foley catheter is removed (called a “trial of void” or “void trial”). •You may be discharged home with a medication called PYRIDIUM that will help with the "burning" pain you may experience when voiding. This medication may turn your urine bright orange. •Colace has been prescribed to avoid post surgical constipation and constipation related to narcotic pain medication. Discontinue if loose stool or diarrhea develops. Colace is a stool softener, NOT a laxative, and it is available over-the-counter •AVOID STRAINING for bowel movements as this may stir up bleeding. Avoid constipating foods for ___ weeks, and drink plenty of fluids to keep hydrated •No vigorous physical activity or sports for 4 weeks or until otherwise advised •Do not lift anything heavier than a phone book (10 pounds) or participate in high intensity physical activity (which includes intercourse) for a minimum of four weeks or until you are cleared by your Urologist in follow-up •Acetaminophen (Tylenol) should be your first-line pain medication. A narcotic pain medication may also be prescribed for breakthrough or moderate pain. •The maximum daily Tylenol/Acetaminophen dose is 3 grams from ALL sources. •Do not drive or drink alcohol while taking narcotics and do not operate dangerous machinery.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler ___ PUFF IH Q6H:PRN sob 2. Fluticasone Propionate NASAL 1 SPRY NU BID 3. Ascorbic Acid ___ mg PO DAILY 4. Aspirin 81 mg PO DAILY 5. Clindamycin 300 mg PO Q8H 6. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 7. FoLIC Acid 1 mg PO DAILY 8. Metoprolol Tartrate 75 mg PO BID 9. Montelukast 10 mg PO DAILY 10. Omeprazole 40 mg PO DAILY 11. Thiamine 100 mg PO DAILY 12. Multivitamins 1 TAB PO DAILY 13. Allopurinol ___ mg PO DAILY 14. Tiotropium Bromide 1 CAP ___ DAILY Discharge Disposition: Home Discharge Diagnosis: Hyperkalemia and ___ of multifactorial origin Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure treating you at the ___ ___. You were admitted because of your high potassium level and abnormal kidney function lab markers. In the emergency department, you were given fluids and admitted overnight for further monitoring of your electrolyte balance. In the morning, your kidney function and potassium level (along with other electrolytes) improved. We continued your fluids while holding your lisinopril. Afternoon labs returned with continued improvement and you were discharged to ___ with with your PCP. ***PLEASE USE LAB SCRIPT TO HAVE BLOOD DRAWN ___, LABS SHOULD BE FAXED TO ___ ___ ___ STOP: -- Lisinopril until you see your PCP or ___ HOLD: -- Warfarin, while taking Lovenox per Dr. ___ your ___ Fissure Procedure Best of Health, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H 2. Ibuprofen 600 mg PO Q8H:PRN pain Please take with water and food Discharge Disposition: Home Discharge Diagnosis: -Hypercalcemia -Primary hyperparathyroidism Discharge Condition: Alert and oriented x3, cohesive Ambulating per baseline Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at ___. WHY WAS I ADMITTED TO THE HOSPITAL? -You were admitted to the hospital because you were found to have a high calcium level in your blood. WHAT HAPPENED WHILE I WAS IN THE HOSPITAL? -You got IV fluids to help lower the calcium in your blood. When you were not on IV fluids, the calcium level went back up. -You were seen by the endocrinology team, who believe the high calcium level is due to an issue with your parathyroid gland (the gland that controls calcium levels in your blood). -You were seen by the endocrine surgery team, who recommended surgery to remove the parathyroid glands. You were taken to the OR on ___ for a right upper parathyroidectomy with Dr. ___. You tolerated this procedure well and recovered uneventfully. You were discharged home once you were eating, on oral medications, walking, and completing daily activities per normal. MEDICATIONS: For pain medication you may take acetaminophen (Tylenol) or ibuprofen (Motrin). You requested a recovery without opioid analgesics and achieved appropriate pain control without them postoperatively. You may restart all your usual home medications. SYMPTOMS OF LOW CALCIUM: If you develop tingling or numbness around your mouth, fingertips or legs, this may be a sign of a low calcium and you should call our office. If you develop severe symptoms, please go to emergency room. WOUND CARE: You may shower normally starting tonight. Allow warm soapy water to run over the wound, rinse and pat dry gently. There is no need to keep a dressing over the wound. Do not apply creams or ointments. Do not submerge the wound in a swimming pool or bath until cleared at your follow up visit. Do not pull off the steri strip tapes--these will fall off by themselves over the next ___ weeks. DIET: You may resume your regular home diet without restriction. You should stick to foods that do not upset your stomach. You may need to start with small meals first and may not feel very hungry at first. This will improve over time. You may supplement your diet with protein shakes as needed if you do not feel you are taking in enough nutrition. ACTIVITY: You may resume all of your normal home activities, except for straining or lifting heavy weight. We recommend you resume walking, exercise, bathing, per your normal regimen. WARNING SIGNS: You should contact our clinic or return to the ED immediately if you experience any of the following signs or symptoms: Fever above 101.5 Worsening pain Worsening GI upset, nausea/vomiting, diarrhea Change in the appearance of your incision, or redness, swelling, or change in drainage from your incision Any other symptoms that concern you You can contact our clinic at any time with questions or concerns. You should be seen in our clinic for follow up following your discharge from the hospital. Best wishes, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: N/A Discharge Disposition: Expired Discharge Diagnosis: Primary diagnosis: Large left MCA stroke with hemorrhagic conversion Cause of death: Cardiopulmonary arrest Discharge Condition: Pt expired on ___ at 9:59pm Followup Instructions: ___ [/INST] </s><s>To Whom It ___ Concern, Mrs. ___ was hospitalized due to symptoms of right sided weakness and difficulty with speech resulting from an ACUTE ISCHEMIC STROKE, a condition where a blood vessel providing oxygen and nutrients to the brain is blocked by a clot. The brain is the part of your body that controls and directs all the other parts of your body, so damage to the brain from being deprived of its blood supply can result in a variety of symptoms. After family meeting on ___ at 2pm, decision was made to employ comfort measures only and further intervention was withheld. Patient passed peacefully on ___ at 9PM, with son at bedside.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ciprofloxacin HCl 500 mg PO BID gastroenteritis 2. MetroNIDAZOLE 500 mg PO TID 3. Ferrous Sulfate 325 mg PO DAILY 4. Hydroxychloroquine Sulfate 200 mg PO DAILY 5. ketotifen fumarate 0.025 % (0.035 %) ophthalmic (eye) BID 6. Levothyroxine Sodium 200 mcg PO DAILY 7. Lisinopril 10 mg PO DAILY 8. Mycophenolate Mofetil 1500 mg PO BID 9. Pantoprazole 40 mg PO Q24H Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSES Gastroenteritis Acute kidney injury Hypovolemic hyponatremia Hypotension Bright red blood per rectum SECONDARY DIAGNSES Mixed connective tissue disease Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at the ___ ___! WHY WAS I IN THE HOSPITAL? ========================== - You were admitted because you were having diarrhea, vomiting, and your blood pressure was low WHAT HAPPENED IN THE HOSPITAL? ============================== - You were diagnosed with gastroenteritis, a problem caused by a bacteria or virus - You were started on antibiotics for possible bacteria and given IV fluids WHAT SHOULD I DO WHEN I GO HOME? ================================ - Be sure to take all your medications and attend all of your appointments listed below. Thank you for allowing us to be involved in your care, we wish you all the best! Your ___ Healthcare Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>INSTRUCTIONS AFTER HAND SURGERY: - You were in the hospital for hand surgery. It is normal to feel tired or "washed out" after surgery, and this feeling should improve over the first few days to week. - Resume your regular activities as tolerated, but please follow your weight bearing precautions strictly at all times. ACTIVITY AND WEIGHT BEARING: - Nonweight bearing right upper extremity, OK for finger range of motion as taught by the occupational therapist MEDICATIONS - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. ANTICOAGULATION: - Please take Aspirin 121.5 daily for 4 weeks WOUND CARE: - Dressing should remain on at all times. Do not remove. Do not get wet. You may shower. No baths or swimming for at least 4 weeks. - Splint must be left on until follow up appointment unless otherwise instructed DANGER SIGNS: Please call your PCP or surgeon's office and/or return to the emergency department if you experience any of the following: - Increasing pain that is not controlled with pain medications - Increasing redness, swelling, drainage, or other concerning changes in your incision - Persistent or increasing numbness, tingling, or loss of sensation - Fever > 101.4 - Shaking chills - Chest pain - Shortness of breath - Nausea or vomiting with an inability to keep food, liquid, medications down - Any other medical concerns FOLLOW UP: -Please follow up with Dr. ___ in the Hand Surgery Clinic for post-operative evaluation. You have an appointment scheduled for ___ at 11AM in ___. ___ ___ -Please follow up with your primary care doctor regarding this admission within ___ weeks for any new medications/refills.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Brimonidine Tartrate 0.15% Ophth. 1 DROP BOTH EYES Q12H 3. Fish Oil (Omega 3) 1000 mg PO DAILY 4. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES HS 5. Lisinopril 40 mg PO DAILY 6. Multivitamins 1 TAB PO DAILY 7. Vitamin D 1000 UNIT PO DAILY 8. Cyanocobalamin 1000 mcg PO DAILY 9. FoLIC Acid 1 mg PO DAILY 10. Nystatin Cream 1 Appl TP BID Duration: 14 Days 11. Acetaminophen 650 mg PO Q6H Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Acute toxic metabolic encephalopathy L1 spinal compression fracture with retropulsion Secondary: Hypertension Chronic kidney disease Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to ___ because you fell and fractured your spine. You had an MRI of your spine that showed a compression fracture of your spine but did not show any acute compression of your spinal cord. You were seen by the Orthopedic Spine team, who did not think you needed surgery. While you were here you got confused, which we think was caused by pain medications that you took. We also found that you had low vitamin B12, so we started you on supplementation that you should continue to take at home. Before you left you were fitted with a brace for your back that you should use when you are up walking. You will have a follow-up appointment with your primary care doctor (___) and the Orthopedic Spine clinic. It was a pleasure participating in your care - we wish you all the best. Sincerely, Your ___ Medicine Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. acetaminophen 325 mg Tablet Sig: ___ Tablets PO Q6H (every 6 hours) as needed for pain. 2. amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. famotidine 20 mg Tablet Sig: One (1) Tablet PO once a day. 4. lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: One (1) Adhesive Patch, Medicated Topical DAILY (Daily) as needed for pain. 5. bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal DAILY (Daily) as needed for constipation. 6. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. 7. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Rheumatoid Arthritis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital for pain in your body, mostly in your ribs. We tried to treat your pain with pills and a pain patch but you did not wish to take any pain medications. Our physical therapists worked with you and felt you would benefit from rehab. We also had our psychiatrists see you to discuss your mood but you declined further treatment. Please follow-up with your PCP after you leave rehab. We made an appointment for you to see ENT to discuss your ear pain as below.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Acetaminophen 1000 mg PO Q8H 3. Aluminum-Magnesium Hydrox.-Simethicone ___ ml PO Q6H:PRN Dyspepsia 4. Docusate Sodium 100 mg PO BID 5. Enoxaparin Sodium 40 mg SC QPM Duration: 14 Days Start: Today - ___, First Dose: Next Routine Administration Time 6. OxycoDONE (Immediate Release) 2.5-5 mg PO Q4H:PRN Pain RX *oxycodone 5 mg ___ tablet(s) by mouth Q4-6H Disp #*60 Tablet Refills:*0 7. Senna 8.6 mg PO BID Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Left hip periprosthetic fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Instructions After Orthopedic Surgery - You were in the hospital for orthopedic surgery. It is normal to feel tired or "washed out" after surgery, and this feeling should improve over the first few days to week. - Resume your regular activities as tolerated, but please follow your weight bearing precautions strictly at all times. Medicines - Resume taking your home medications unless specifically instructed to stop by your surgeon. Please talk to your primary care doctor within the next ___ weeks regarding this hospitalization and any changes to your home medications that may be necessary. - Do not drink alcohol, drive, or operate machinery while you are taking narcotic pain relievers (oxycodone/dilaudid). - As your pain lessens, decrease the amount of narcotic pain relievers you are taking. Instead, take acetaminophen (also called tylenol). Follow all instructions on the medication bottle and never take more than 4,000mg of tylenol in a single day. - If you need medication refills, call your surgeon's office 3-to-4 days before you need the refill. Your prescriptions will be mailed to your home. - Please take lovenox for two weeks to help prevent the formation of blood clots. Constipation - Both surgery and narcotic pain relievers can cause constipation. Please follow the advice below to help prevent constipation. - Drink 8 glasses of water and/or other fluids like juice, tea, and broth to stay well hydrated. - Eat foods that are high in fiber like fruits and vegetables. - Please take a stool softener like docusate (also called colace) to help prevent constipation while you are taking narcotic pain relievers. - You may also take a laxative such as senna (also called Senokot) to help promote regular bowel movements. - You can buy senna or colace over the counter. Stop taking them if your bowel movements become loose. If your bowel movements continue to stay loose after stopping these medications, please call your doctor. Incision - Please return to the emergency department or notify your surgeon if you experience severe pain, increased swelling, decreased sensation, difficulty with movement, redness or drainage at the incision site. - You can get the wound wet/take a shower starting 3 days after surgery. Let water run over the incision and do not vigorously scrub the surgical site. Pat the area dry after showering. - No baths or swimming for at least 4 weeks after surgery. - Your staples/sutures will be taken out at your 2-week follow up appointment. No dressing is needed if your wound is non-draining. - You may put an ice pack on your surgical site, but do not put the ice pack directly on your skin (place a towel between your skin and the ice pack), and do not leave it in place for more than 20 minutes at a time. Activity - Your weight-bearing restrictions are: touch down weight bearing in the right lower extremity Physical Therapy: TDWB LLE ROMAT Walker when upright Treatments Frequency: Daily dressing changes until wound without drainage. Then, leave open to air. Stitches/staples to be removed at scheduled follow up in 2 weeks</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Chlorthalidone 25 mg PO DAILY 2. Morphine SR (MS ___ 30 mg PO DAILY 6PM restless leg syndrome 3. OxycoDONE (Immediate Release) 10 mg PO BEDTIME breakthrough pain 4. Warfarin 7.5 mg PO DAILY16 Discharge Disposition: Home Discharge Diagnosis: Primary: idiopathic headache, diplopia Secondary: hypertension, pulmonary embolisms on coumadin, hyperlipidemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted for symptoms of headache and double vision. Your imaging results (CT of the head, and MRI of the brain) did not show any acute pathology to explain your headache. Your neurological exam is relatively benign, but we recommend close follow up with our neuro-ophthamologists (Dr. ___ and neurology clinics (Drs. ___. Please call either office (phone numbers below) if you have any change or worsening of your symptoms. Please continue to take your anti-hypertensive medication (Chlorthalidone) and warfarin as directed. You have scheduled follow up in the ___ clinic on ___. It was a pleasure caring for you during this hospitalization.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN shortness of breath 2. Fluticasone Propionate NASAL 2 SPRY NU DAILY 3. Ipratropium Bromide Neb 1 NEB IH Q6H:PRN SOB, wheezing 4. Montelukast Sodium 10 mg PO DAILY 5. Guaifenesin ER 600 mg PO Q12H 6. Salmeterol Xinafoate Diskus (50 mcg) 1 INH IH Q12H 7. Tiotropium Bromide 1 CAP IH DAILY 8. CefePIME 2 g IV Q12H 9. Fluticasone Propionate 110mcg 2 PUFF IH BID with spacer 10. Vancomycin 1000 mg IV Q 12H Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS: Multilobar Pneumonia COPD Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>It was a pleasure taking care of you at ___ ___. You were admitted to the hospital for shortness of breath and cough. A chest CT was obtained which suggested a worsening pneumonia. You were treated with IV antibiotics and nebulizers. Your oxygen saturations were monitored. The pulmonology team was consulted and recommended that you be discharged on IV antibiotics, and that you start taking the medication fluticasone. Your serum creatinine (a measure of kidney function) also rose during this admission. This was monitored and remained stable at the time of discharge. You were also started on Flomax (also known as Tamsulosin) for your prostate. Please arrange for follow-up appointment with Urology as you had previously planned. Let your primary care physician know if you start to experience dizziness or lightheadedness while on this medication. Please attend all of your follow-up appointments. Given your infection, you will go home on IV antibiotics. You should also start taking fluticasone with a spacer. Please continue all of your other medications. Please follow up with your primary care doctor regarding your kidney function.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>you have facial skin infection you are leaving against medical advice after the risks were explained to you. you can lose your vision and cause severe problems please seek medical attention if you develop worsened symptoms of redness, pain, headache, neck stiffness, visual changes</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. HYDROmorphone (Dilaudid) ___ mg PO Q4H RX *hydromorphone [Dilaudid] 2 mg 1 tablet(s) by mouth every 4 hours as needed Disp #*20 Tablet Refills:*0 2. Gabapentin 1200 mg PO TID RX *gabapentin 600 mg 2 capsule(s) by mouth three times a day Disp #*45 Tablet Refills:*0 3. Glargine 40 Units Dinner Humalog 10 Units Breakfast Humalog 10 Units Lunch Humalog 10 Units Dinner Insulin SC Sliding Scale using HUM Insulin 4. Acetaminophen 1000 mg PO Q8H 5. amLODIPine 5 mg PO DAILY 6. Citalopram 30 mg PO DAILY 7. Lisinopril 40 mg PO DAILY 8. Multivitamins 1 TAB PO DAILY 9. Prazosin 5 mg PO BID 10. Prazosin 2 mg PO DAILY 11. Thiamine 100 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: pancreatitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you during your hospitalization at ___! Why did you come to the hospital? - Because you were having abdominal pain What happened while you were in the hospital? - You were found to have acute pancreatitis, for which you received iv fluids and pain medication - You were found to be in alcohol withdrawal and required several doses of phenobarbital before you improved - You were also found to have alcoholic hepatitis which improved. - Your diabetes was also noted to be poorly controlled and your insulin regimen was titrated in the hospital. Please follow up with your doctor for any changes. - You were seen by our social worker who tried to offered resources to help you maintain sobriety. What should you do after you leave the hospital? -REGARDING YOUR PAIN MEDICATION: Please take dilaudid 4 mg every 4 hours for the rest of today. Then tomorrow, take 2 mg every 4 hours. Then on ___, take 2 mg every 6 hours. Then on ___, take 2 mg every 8 hours. Then on ___, take 2 mg every 12 hours and go for your suboxone appointment. - Please continue to work on staying sober! You know how important it is, and we believe that you can be successful this time. - Follow up with your primary care doctor about your pain, suboxone management and your diabetes - Please schedule an appointment with our Liver clinic to follow up on your alcoholic hepatitis and Hepatitis C We wish you the best! Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ciprofloxacin HCl 500 mg PO BID Duration: 7 Days RX *ciprofloxacin HCl [Cipro] 500 mg 1 tablet(s) by mouth twice a day Disp #*14 Tablet Refills:*0 2. MetroNIDAZOLE 500 mg PO Q8H RX *metronidazole 500 mg 1 tablet(s) by mouth every eight (8) hours Disp #*21 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS =================== Terminal Ileitis SECONDARY DIAGNOSIS ====================== Peptic Ulcer Disease Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, WHY WAS I ADMITTED TO THE HOSPITAL? ====================================== - You were having abdominal pain and had a CT scan that showed a bad infection. WHAT HAPPENED IN THE HOSPITAL? =================================== - You were started on antibiotics. - You were seen by the gastroenterologists who recommended that you continue antibiotics and follow up with them as an outpatient. WHAT SHOULD I DO WHEN I GO HOME? ================================= - You should continue your antibiotics. - You should be receiving a call early this week to schedule a colonoscopy. - Please call your PCP, ___, to schedule follow up in ___ weeks. Take care, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen (Liquid) 650 mg PO Q6H:PRN pain RX *acetaminophen 160 mg/5 mL (5 mL) 15 ml by mouth every six (6) hours Disp #*300 Milliliter Refills:*0 2. OxycoDONE Liquid ___ mg PO Q4H:PRN pain Do not drive or operate other machinery while using RX *oxycodone 5 mg/5 mL ___ ml by mouth every four (4) hours Refills:*0 3. Ibuprofen Suspension 600 mg PO Q6H:PRN pain RX *ibuprofen 100 mg/5 mL 30 ml by mouth every six (6) hours Refills:*0 4. Sodium Chloride Nasal ___ SPRY NU QID:PRN nose dryness RX *sodium chloride [Ocean Nasal] 0.65 % ___ spray Both nostrils four times a day Disp #*50 Spray Refills:*0 5. Cephalexin 500 mg PO Q6H Duration: 7 Days RX *cephalexin 500 mg 1 capsule(s) by mouth every six (6) hours Disp #*28 Capsule Refills:*0 6. Chlorhexidine Gluconate 0.12% Oral Rinse 15 mL ORAL BID RX *chlorhexidine gluconate 0.12 % Swich and spit twice a day Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Bilateral LeFort I fractures, right LeFort II fracture, and left LeFort III fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were seen following a fall after a bicycle ride. You sustained multiple facial fractures for which you were taken to the operating room with the Oral Maxillo-Facial Surgery service. You tolerated your procedure and post-operative course well, your packing was removed prior to discharge, and you are now both voiding reliably and taking in enough liquids for discharge. You can have a full liquid diet as you had in the hospital. Make sure you are taking in plenty of calories and protein; we recommend taking nutritional supplements like "Ensure" three times daily with meals to help make sure you are taking in enough nutrition. You may resume your regular level of activities but you must not drive nor operate any other form of machinery while under the influence of narcotic pain medicine like oxycodone. Do not take more pain medicine than needed. Take Keflex (cephalexin), an antibiotic, four times daily for 1 week as prescribed. Please resume all other prescribed medicines you were taking at home before your accident. Take pain medicine as needed but do not take more than you need and NEVER operate a vehicle or other machinery while using narcotic pain medicine. Use your prescription mouth rinse twice daily. Use nasal spray as needed. Please follow up in clinic with OMFS and also with occuloplastic surgery as described below. You do not need to follow up with the ___ clinic.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN pain 2. Lactulose 20 mL PO TID 3. Multivitamins 1 TAB PO DAILY 4. Omeprazole 20 mg PO DAILY 5. Rifaximin 550 mg PO BID 6. Tamsulosin 0.4 mg PO HS 7. TraZODone 12.5 mg PO HS:PRN insomnia 8. Ciprofloxacin HCl 500 mg PO Q12H to continue through end of ___ RX *ciprofloxacin [Cipro] 500 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*7 Tablet Refills:*0 9. Bisacodyl 10 mg PR HS:PRN constipation 10. Calcium Carbonate 500 mg PO DAILY avoid giving at same time as ciprofloxacin. 11. Fluocinolone Acetonide 0.025% Ointment 1 Appl TP BID:PRN face rash 12. FoLIC Acid 1 mg PO DAILY 13. Metoclopramide 10 mg PO QIDACHS 14. Milk of Magnesia 30 mL PO DAILY:PRN constipation avoid giving at same time as ciprofloxacin. 15. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN pain 16. Prochlorperazine 10 mg PO Q6H:PRN nausea, vomiting 17. Simethicone 160 mg PO TID:PRN GI distress 18. Thiamine 1 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary Diagnosis: Cholangitis Biliary obstruction (choledocholithiasis) Secondary Diagnosis: Esophageal varices, grade I-II Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure caring for you during your hospitalization. You were admitted on ___ due to abdominal pain. You underwent an extensive work-up which found that you had a blockage in your bile ducts (tubes that carry bile away from the liver) and this led to an infection. You were given antibiotics and also underwent a procedure to remove the blockage. You did very well with this treatment and are now improved enough to return home. Please be sure to follow-up at the appointments below. If you develop any fevers, chills, abdominal pain, or other concerning symptoms, please call your doctor right away.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain Do not operate any vehicles or heavy machinery RX *oxycodone 5 mg ___ tablet(s) by mouth Every 6 hours or as needed Disp #*20 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Appendicitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital with acute appendicitis. You were taken to the operating room and had your appendix removed laparoscopically. You tolerated the procedure well and are now being discharged home with the following instructions: Please follow up at the appointment in clinic as listed below. We also generally recommend that patients follow up with their primary care provider after having surgery. ACTIVITY: Do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. You may climb stairs. You may go outside, but avoid traveling long distances until you see your surgeon at your next visit. Don't lift more than ___ lbs for ___ weeks. (This is about the weight of a briefcase or a bag of groceries.) This applies to lifting children, but they may sit on your lap. You may start some light exercise when you feel comfortable. You will need to stay out of bathtubs or swimming pools for a time while your incision is healing. Ask your doctor when you can resume tub baths or swimming. HOW YOU MAY FEEL: You may feel weak or "washed out" a couple weeks. You might want to nap often. Simple tasks may exhaust you. You may have a sore throat because of a tube that was in your throat during surgery. You could have a poor appetite for a couple days. Food may seem unappealing. All of these feelings and reactions are normal and should go away in a short time. If they do not, tell your surgeon. YOUR INCISION: Tomorrow you may shower and remove the gauzes over your incisions. Under these dressings you have small plastic bandages called steristrips. Do not remove steri-strips for 2 weeks. (These are the thin paper strips that might be on your incision.) But if they fall off before that that's okay. Your incisions may be slightly red around the stitches. This is normal. You may gently wash away dried material around your incision. Avoid direct sun exposure to the incision area. Do not use any ointments on the incision unless you were told otherwise. You may see a small amount of clear or light red fluid staining your dressing or clothes. If the staining is severe, please call your surgeon. You may shower. As noted above, ask your doctor when you may resume tub baths or swimming. YOUR BOWELS: Constipation is a common side effect of narcotic pain medicaitons. If needed, you may take a stool softener (such as Colace, one capsule) or gentle laxative (such as milk of magnesia, 1 tbs) twice a day. You can get both of these medicines without a prescription. If you go 48 hours without a bowel movement, or have pain moving the bowels, call your surgeon. PAIN MANAGEMENT: It is normal to feel some discomfort/pain following abdominal surgery. This pain is often described as "soreness". Your pain should get better day by day. If you find the pain is getting worse instead of better, please contact your surgeon. You will receive a prescription for pain medicine to take by mouth. It is important to take this medicine as directed. Do not take it more frequently than prescribed. Do not take more medicine at one time than prescribed. Do not drink alcohol or drive while taking narcotic pain medication. Your pain medicine will work better if you take it before your pain gets too severe. Talk with your surgeon about how long you will need to take prescription pain medicine. Please don't take any other pain medicine, including non-prescription pain medicine, unless your surgeon has said its okay. If you are experiencing no pain, it is okay to skip a dose of pain medicine. Remember to use your "cough pillow" for splinting when you cough or when you are doing your deep breathing exercises. If you experience any of the following, please contact your surgeon: - sharp pain or any severe pain that lasts several hours - pain that is getting worse over time - pain accompanied by fever of more than 101 - a drastic change in nature or quality of your pain MEDICATIONS: Take all the medicines you were on before the operation just as you did before, unless you have been told differently. If you have any questions about what medicine to take or not to take, please call your surgeon.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q8H:PRN pain 2. Amlodipine 10 mg PO DAILY 3. Aspirin 81 mg PO DAILY 4. Atenolol 50 mg PO BID 5. Calcium Carbonate 500 mg PO TID 6. Citalopram 30 mg PO DAILY 7. Moexipril 15 mg PO BID 8. Multivitamins 1 TAB PO DAILY 9. Pantoprazole 40 mg PO Q12H 10. Vitamin D ___ UNIT PO DAILY 11. cycloSPORINE *NF* 0.05 % ___ BID 12. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: advancing dementia Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Ms. ___, You were admitted to ___ for care of advancing dementia. You will need further outpatient management to help better care for you at home. It is very important that you follow up with Dr. ___ ___ at 10am (see contact information below).</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Cyanocobalamin 100 mcg PO DAILY 3. Fish Oil (Omega 3) 1000 mg PO BID 4. Levoxyl (levothyroxine) 75 mcg oral DAILY 5. Vitamin D ___ UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: 1)Left lumbar radiculopathy 2) Meralgia paresthetica or lateral femoral cutaneous neuropathy is numbness or pain in the outer thigh caused by injury or irritation to a nerve that extends from the spinal column to the thigh. Patient did not have a TIA or STROKE Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mrs. ___ you were admitted to ___ for evaluation of reported left sided sensory changes. You had a full neurological workup which was negative for stroke and TIA. We encourage you to continue to take your home medications, no changes were made to your home medications.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H 2. Docusate Sodium 100 mg PO BID 3. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*20 Tablet Refills:*0 4. Senna 8.6 mg PO BID:PRN constipaton Discharge Disposition: Home Discharge Diagnosis: appendicitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital with abdominal pain. You underwent a cat scan which showed appendicitis. You were taken to the operating room to have your appendix removed. You are recovering from your surgery. You are preparing for discharge with the following instructions: You were admitted to the hospital with acute appendicitis. You were taken to the operating room and had your appendix removed laparoscopically. You tolerated the procedure well and are now being discharged home with the following instructions: Please follow up at the appointment in clinic listed below. We also generally recommend that patients follow up with their primary care provider after having surgery. We have scheduled an appointment for you listed below. ACTIVITY: Do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. You may climb stairs. You may go outside, but avoid traveling long distances until you see your surgeon at your next visit. Don't lift more than ___ lbs for ___ weeks. (This is about the weight of a briefcase or a bag of groceries.) This applies to lifting children, but they may sit on your lap. You may start some light exercise when you feel comfortable. You will need to stay out of bathtubs or swimming pools for a time while your incision is healing. Ask your doctor when you can resume tub baths or swimming. HOW YOU MAY FEEL: You may feel weak or "washed out" a couple weeks. You might want to nap often. Simple tasks may exhaust you. You may have a sore throat because of a tube that was in your throat during surgery. You could have a poor appetite for a couple days. Food may seem unappealing. All of these feelings and reactions are normal and should go away in a short time. If they do not, tell your surgeon. YOUR INCISION: Tomorrow you may shower and remove the gauzes over your incisions. Under these dressings you have small plastic bandages called steristrips. Do not remove steri-strips for 2 weeks. (These are the thin paper strips that might be on your incision.) But if they fall off before that that's okay. Your incisions may be slightly red around the stitches. This is normal. You may gently wash away dried material around your incision. Avoid direct sun exposure to the incision area. Do not use any ointments on the incision unless you were told otherwise. You may see a small amount of clear or light red fluid staining your dressing or clothes. If the staining is severe, please call your surgeon. You may shower. As noted above, ask your doctor when you may resume tub baths or swimming. YOUR BOWELS: Constipation is a common side effect of narcotic pain medicaitons. If needed, you may take a stool softener (such as Colace, one capsule) or gentle laxative (such as milk of magnesia, 1 tbs) twice a day. You can get both of these medicines without a prescription. If you go 48 hours without a bowel movement, or have pain moving the bowels, call your surgeon. PAIN MANAGEMENT: It is normal to feel some discomfort/pain following abdominal surgery. This pain is often described as "soreness". Your pain should get better day by day. If you find the pain is getting worse instead of better, please contact your surgeon. You will receive a prescription for pain medicine to take by mouth. It is important to take this medicine as directed. Do not take it more frequently than prescribed. Do not take more medicine at one time than prescribed. Do not drink alcohol or drive while taking narcotic pain medication. Your pain medicine will work better if you take it before your pain gets too severe. Talk with your surgeon about how long you will need to take prescription pain medicine. Please don't take any other pain medicine, including non-prescription pain medicine, unless your surgeon has said its okay. If you are experiencing no pain, it is okay to skip a dose of pain medicine. Remember to use your "cough pillow" for splinting when you cough or when you are doing your deep breathing exercises. If you experience any of the following, please contact your surgeon: - sharp pain or any severe pain that lasts several hours - pain that is getting worse over time - pain accompanied by fever of more than 101 - a drastic change in nature or quality of your pain MEDICATIONS: Take all the medicines you were on before the operation just as you did before, unless you have been told differently. If you have any questions about what medicine to take or not to take, please call your surgeon. DANGER SIGNS: Please call your surgeon if you develop: - worsening abdominal pain - sharp or severe pain that lasts several hours - temperature of 101 degrees or higher - severe diarrhea - vomiting - redness around the incision that is spreading - increased swelling around the incision - excessive bruising around the incision - cloudy fluid coming from the wound - bright red blood or foul smelling discharge coming from the wound - an increase in drainage from the wound</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr. ___, It was a pleasure caring for you while you were admitted to ___. You were admitted because you were having abdominal pain. A CT scan of your abdomen showed some mild inflammation but otherwise no evidence of a serious acute process. Your blood tests were all reassuring. It is possible that you have a viral infection or a small ulcer. You were treated with intravenous fluids and some medications to settle your stomach. . In the emergency department you were also found to have a small abscess on your abdomen that was drained. You were started on an antibiotic called clindamycin for this. Please take the entire course of the medication, even if you start to feel better. If you experience increasing redness or pain at the site of your abscess, please call your primary care physician or visit the Emergency Department. . The following changes have been made to your medication regimen Please START taking - clindamycin (continue until ___ - omeprazole (to reduce stomach acid) - maalox (to relief stomach pain and irritation) . Please take your medications as prescribed and follow up with your doctors as ___.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amitriptyline 50 mg PO QHS 2. Amlodipine 10 mg PO DAILY 3. Citalopram 40 mg PO DAILY 4. Fluticasone Propionate NASAL 1 SPRY NU DAILY 5. Gabapentin 400 mg PO BID RX *gabapentin 400 mg 1 capsule(s) by mouth twice a day Disp #*30 Capsule Refills:*0 6. Labetalol 200 mg PO TID RX *labetalol 200 mg 1 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*0 7. Multivitamins 1 TAB PO DAILY 8. Mycophenolate Sodium ___ 360 mg PO BID RX *mycophenolate sodium 360 mg 1 tablet(s) by mouth twice daily Disp #*60 Tablet Refills:*0 9. Omeprazole 40 mg PO BID 10. Ondansetron 4 mg PO Q8H:PRN Nausea 11. Vitamin D 1000 UNIT PO DAILY 12. Allopurinol ___ mg PO DAILY RX *allopurinol ___ mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 13. ALPRAZolam 0.5 mg PO DAILY:PRN anxiety 14. Atorvastatin 10 mg PO QPM 15. Calcium 500 + D (D3) (calcium carbonate-vitamin D3) 500 mg(1,250mg) -125 unit oral daily 16. Sulfameth/Trimethoprim SS 1 TAB PO DAILY RX *sulfamethoxazole-trimethoprim 400 mg-80 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 17. PredniSONE 5 mg PO DAILY RX *prednisone 5 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 18. Albuterol Inhaler ___ PUFF IH Q6H:PRN wheezing RX *albuterol ___ puff IH every 6 hours Disp #*1 Inhaler Refills:*0 Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS 1. Acute Kidney Rejection 2. BK nephropathy and viremia SECONDARY DIAGNOSIS: 1. Alport Syndrome Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you during your hospital stay at ___. You were initially admitted to the hospital for concerns about your transplanted kidney. During your hospital stay, you were given several rounds of treatment to help prevent rejection of your transplanted kidney. Unfortunately, with treatment your kidney function began to worsen and we had to start dialysis. Before leaving the hospital, we have changed your immunosuppression, and set you up with dialysis as an outpatient. You have surgery scheduled for fistula placement on ___, ___. Please arrive at the Main Entrance of the ___ ___ at 8:15am. Please do not eat or drink anything past midnight the night before the procedure. Many changes were made to your home medication regimen, please continue to take medications as prescribed. Please follow up with your primary care physician and your transplant nephrologist upon leaving from the hospital. We have also set up appointments for you to meet with the transplant surgery team to develop long-term solution for your dialysis. Take Care, Your ___ Team.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>You were admitted to the hospital after being struck by a car. You were thrown 20 - 30 feet and lost consciousness. Your injuries include a left fibula fracture (smaller of the two long bones connecting your knee to ankle) and a left flank (side) hematoma. You were admitted to the intensive care unit after the accident. You were transferred to the floor after you were assessed to be stable enough for transfer. You are slowly recovering and will need continuing rehab after your inpatient stay. Please resume all regular home medications, unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. CARVedilol 3.125 mg PO BID 2. Glargine 24 Units Breakfast Humalog 2 Units Breakfast Humalog 2 Units Lunch Humalog 2 Units Dinner Insulin SC Sliding Scale using HUM Insulin 3. LevETIRAcetam 750 mg PO BID 4. Miconazole Nitrate Vag Cream 2% 1 Appl VG QHS Duration: 7 Days 5. Losartan Potassium 100 mg PO DAILY 6. HELD- Atorvastatin 80 mg PO QPM This medication was held. Do not restart Atorvastatin until your outpatient provider decides to restart 7. HELD- GlipiZIDE 10 mg PO BID This medication was held. Do not restart GlipiZIDE until outpatient provider decides to restart Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Subarachnoid hemorrhage Seizure Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were hospitalized due to symptoms of confusion resulting from a hemorrhagic STROKE, a condition where there is a bleed in the brain resulting in parts of the brain not getting enough oxygen. The brain is the part of your body that controls and directs all the other parts of your body, so damage to the brain from being deprived of its blood supply can result in a variety of symptoms. You then proceeded to have a seizure. Stroke can have many different causes, so we assessed you for medical conditions that might raise your risk of having stroke. In order to prevent future strokes, we plan to modify those risk factors. Your risk factors are: - Diabetes - High blood pressure We are changing your medications as follows: - We are stopping your aspirin - We are holding your atorvastatin - We added Keppra 750mg BID for seizure prevention Please take your other medications as prescribed. Please follow up with Neurology and your primary care physician as listed below. If you experience any of the symptoms below, please seek emergency medical attention by calling Emergency Medical Services (dialing 911). In particular, since stroke can recur, please pay attention to the sudden onset and persistence of these symptoms: - Sudden partial or complete loss of vision - Sudden loss of the ability to speak words from your mouth - Sudden loss of the ability to understand others speaking to you - Sudden weakness of one side of the body - Sudden drooping of one side of the face - Sudden loss of sensation of one side of the body Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. bupropion HCl 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. dorzolamide-timolol ___ % Drops Sig: One (1) Drop Ophthalmic BID (2 times a day). 3. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at bedtime). 5. simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. doxazosin 2 mg Tablet Sig: Two (2) Tablet PO once a day. 7. diazepam 10 mg Tablet Sig: One (1) Tablet PO once a day as needed for anxiety. 8. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day for 7 days. Disp:*7 Tablet(s)* Refills:*0* 9. Keflex ___ mg Capsule Sig: One (1) Capsule PO three times a day for 7 days. Disp:*21 Capsule(s)* Refills:*0* 10. warfarin 4 mg Tablet Sig: One (1) Tablet PO once a day. 11. warfarin 2 mg Tablet Sig: One (1) Tablet PO ___ ___: in addition to 4mg tablet for total of 6mg. 12. Outpatient Lab Work CBC, INR and Chem 7 on ___ and results to be faxed to ___. Phone: ___ Fax: ___ 13. potassium chloride 20 mEq Packet Sig: One (1) PO once a day for 7 days. Disp:*7 packets* Refills:*0* Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: Septic shock due to cellulitis and urinary tract infection Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital with severe infection of your leg and urine. You were treated in the intensive care unit followed by treatmet for cellulitis (infection of the leg). With antibiotics your symptoms improved although significant amount of swelling and redness in your leg persisted. You were given water pills to help get rid of some of the water in your legs. In addition, you required wrapping of your legs with ACE bandages to help get rid of the fluid. The following changes were made to your medications. STARTED: - Furosemide 20mg daily for one week - Keflex ___ three times daily - Potassium 20 meq daily for one week STOPPED: - Hydrochlorothiazide - Lisinopril (until you complete your furosemide) Please ensure that you elevate your legs daily and wrap them with ACE bandage. Should you develop any symptoms concerning to you, please call Dr. ___, ___ or go to the emergency room. You have an appointment with Dr. ___ at the end of ___, but his office will contact you to set up a follow up within the next week. If you don't hear from him by middle of next week, please call his office. Please also obtain labs to check your coumadin level next week.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Glargine 5 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 2. Isosorbide Mononitrate (Extended Release) 60 mg PO DAILY 3. Lisinopril 20 mg PO DAILY 4. Miconazole Powder 2% 1 Appl TP TID:PRN rash 5. Multivitamins W/minerals 1 TAB PO DAILY 6. Neomycin-Polymyxin-Bacitracin 1 Appl TP PRN with all dressing changes 7. Senna 17.2 mg PO HS 8. Spironolactone 25 mg PO DAILY 9. Torsemide 40 mg PO DAILY 10. Apixaban 5 mg PO BID 11. Aspirin 81 mg PO DAILY heart disease 12. Cyanocobalamin 250 mcg PO DAILY 13. Vitamin D 1000 UNIT PO DAILY 14. HELD- Atorvastatin 80 mg PO QPM This medication was held. Do not restart Atorvastatin until your liver function tests normalize. 15. HELD- MetFORMIN (Glucophage) 850 mg PO BID This medication was held. Do not restart MetFORMIN (Glucophage) until your doctor tells you to do so. 16. HELD- Metoprolol Succinate XL 100 mg PO BID This medication was held. Do not restart Metoprolol Succinate XL until your doctor tells you to do so. Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary Diagnosis: HFrEF exacerbation Secondary Diagnoses: Acute renal failure Atrial fibrillation with rapid ventricular response Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Lethargic but arousable. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>It was a pleasure taking care of you at ___ ___. WHY WAS I ADMITTED TO THE HOSPITAL? - You were admitted to the hospital because you had recent episode of diarrhea, had fatigue, and were generally feeling unwell. WHAT HAPPENED WHILE I WAS IN THE HOSPITAL? -You were found to be in hear failure, which led to markedly reduced the blood perfusion to the vital organs of the body. -You were given medications to treat heart failure, and to improve heart function. -You underwent kidney replacement therapy while in the CCU to remove excessive fluid -For atrial fibrillation, you underwent a procedure to change the rhythm back to normal, but this did not work. Then you had a procedure to change the electrical conduction in your heart, which fixed the irregular fast rhythm. -You were evaluated by physical therapy, who felt that you should be discharged to a rehab facility for continued therapy. WHAT SHOULD I DO WHEN I GO HOME? - You should continue to take your medications as prescribed. - You should attend the appointments listed below. - Weigh yourself every morning, call your doctor if your weight goes up more than 3 lbs. - Seek medical attention if you have new or concerning symptoms or you develop swelling in your legs, abdominal distention, or shortness of breath at night. - Your discharge weight: 139.55 lb. You should use this as your baseline after you leave the hospital. We wish you the best! Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H:PRN fever, headache 2. Aspirin 81 mg PO DAILY 3. Docusate Sodium 100 mg PO BID 4. Fentanyl Patch 25 mcg/h TD Q72H RX *fentanyl 25 mcg/hour apply 1 patch to skin q72 Disp #*15 Patch Refills:*0 5. Gentamicin 240 mg IV Q24H 6. Lidocaine 5% Patch 1 PTCH TD QPM 7. Lorazepam 0.5 mg PO HS RX *lorazepam 0.5 mg 1 tab by mouth at bedtime Disp #*15 Tablet Refills:*0 8. TraZODone 50 mg PO HS:PRN insomnia 9. Outpatient Lab Work Weekly OPAT labs: CBC, Chem-7, AST, ALT, AlkPhos, ESR, CRP, gentamicin trough. ICD-9: ___ Fax weekly labs to the ___ R.N.s at ___. MD: ___ 10. Meropenem 1000 mg IV Q8H Duration: 13 Days Continue through ___. Enoxaparin Sodium 80 mg SC Q12H Start: Today - ___, First Dose: Next Routine Administration Time Discontinue when INR between ___ x2 days. 12. Warfarin 3 mg PO DAILY 13. Naproxen 500 mg PO Q8H:PRN pain 14. HYDROmorphone (Dilaudid) 2 mg PO Q4H:PRN pain RX *hydromorphone 2 mg 1 tablet(s) by mouth every four (4) hours Disp #*30 Tablet Refills:*0 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY: -Acute subsegmental pulmonary embolism SECONDARY: -Spinal discitis / osteomyelitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure to take care of you at ___ ___. You were admitted to the hospital because of chest pain and found to have a small blood clot in your right lung. You were treated with blood thinners. You were continued on your antibiotics for your blood and spine infection. You had an ultrasound of your PICC line to make sure that this was not the source of the clot in the lung. You also had a transesophageal echocardiogram which did not show any evidence of active infection in the heart at this time. Your antibiotics should continue through ___.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. levothyroxine 175 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. levetiracetam 250 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 3. lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. metformin 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 5. simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Discharge Disposition: Home Discharge Diagnosis: Choledocholithiasis, gallstone pancreatitis. Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to ___ on ___ for gallstone pancreatitis. You received an ERCP with sphincterotomy and stone removal. You have recovered well and are ready to return home to continue your recovery there. MEDICATIONS: Continue all medications you take at home. ACTIVITY: Continue to follow activity restrictions as recommended by Dr. ___. Otherwise, you have no restrictions on your activity.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain do NOT drink alcohol or drive while taking this medication RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*40 Tablet Refills:*0 2. Bisacodyl 10 mg PR QHS:PRN constipation RX *bisacodyl [The Magic Bullet] 10 mg 1 suppository(s) rectally at bedtime Disp #*30 Suppository Refills:*0 3. Docusate Sodium 100 mg PO BID please hold for loose stool RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 4. Senna 8.6 mg PO BID:PRN constipation RX *sennosides [senna] 8.6 mg 1 capsule by mouth twice a day Disp #*60 Capsule Refills:*0 5. Acetaminophen 650 mg PO Q6H:PRN pain RX *acetaminophen 650 mg 1 tablet(s) by mouth every six (6) hours Disp #*63 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Compression fracture of L5 and L3 vertebrae Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to ___ after sustaining a fall. Your injuries were addressed, and you are now ready for discharge. Activity: You may perform all your regular activity as tolerated. Please remember to take pain medicine to make moving easier. Please call the Orhtopaeidic Spine clinic at ___ if you develop any numbness, tingling, weakness, pain not relieved by pain medication, or any other symptoms that concern you.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Apixaban 10 mg PO BID RX *apixaban [Eliquis] 5 mg ASDIR tablet(s) by mouth twice a day Disp #*70 Tablet Refills:*0 2. Azithromycin 250 mg PO Q24H Duration: 4 Days RX *azithromycin 250 mg 1 tablet(s) by mouth once a day Disp #*3 Tablet Refills:*0 3. Lisinopril 10 mg PO DAILY RX *lisinopril 10 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 4. OSELTAMivir 75 mg PO Q12H RX *oseltamivir 75 mg 1 capsule(s) by mouth twice a day Disp #*3 Capsule Refills:*0 5. PredniSONE 40 mg PO DAILY RX *prednisone 20 mg 2 tablet(s) by mouth once a day Disp #*3 Tablet Refills:*0 6. Omeprazole 20 mg PO DAILY 7. Aspirin 81 mg PO DAILY 8. pimecrolimus 1 % topical BID 9. triamcinolone acetonide 0.5 % topical BID Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis ================= Asthma exacerbation secondary to influenza A Pulmonary embolus Secondary Diagnoses =================== Monoclonal gammopathy of undetermined significance Multi-nodular thyroid Gastroesophageal reflux disease Peripheral vascular disease Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to ___ because you were having shortness of breath. You were seen in the emergency room and found to have the flu along with blood clots in your lungs. We treated you for a COPD exacerbation exacerbation with prednisone and azithromycin. We also treated you for the flu with Tamiflu. You will take each of these medication for a 5 day course to end on ___. We started you on a blood thinner medication to treat the blood clots in your lungs called apixiban. You should take 10mg twice a day for the next 5 days followed by 5mg twice a day after that. You were also found to have high blood pressure in the hospital. We started you on a medication called lisinopril. You should continue to take this medication daily until you meet with your primary care physician. Please return to the hospital if you have worsening shortness of breath, fevers, chest pain, or leg swelling. It was a privilege taking care of you and we wish you the best. Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen (Liquid) 650 mg PO Q8H 2. Brimonidine Tartrate 0.15% Ophth. 1 DROP BOTH EYES BID 3. Dorzolamide 2%/Timolol 0.5% Ophth. 1 DROP BOTH EYES BID 4. Furosemide 20 mg PO DAILY 5. Ketoconazole 2% 1 Appl TP BID:PRN itching 6. Omeprazole 20 mg PO DAILY 7. Gabapentin 300 mg PO TID 8. Lidocaine 5% Patch 1 PTCH TD DAILY back pain 9. OxycoDONE (Immediate Release) 5 mg PO Q3H:PRN pain Hold for sedation and RR less than 12 RX *oxycodone 5 mg 1 tablet(s) by mouth every 3 hours Disp #*30 Tablet Refills:*0 10. Bisacodyl 10 mg PR HS:PRN constipation 11. Docusate Sodium 100 mg PO BID Patient may refuse. Hold if patient has loose stools. 12. Lidocaine 5% Patch 1 PTCH TD DAILY knee pain 13. Polyethylene Glycol 17 g PO DAILY 14. Senna 2 TAB PO HS Patient may refuse. Hold if patient has loose stools. 15. Ondansetron 4 mg PO Q8H:PRN nausea 16. OLANZapine (Disintegrating Tablet) 2.5-5 mg PO Q6H:PRN nausea or anxiety Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Pneumonia, Multiple Myeloma Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Lethargic but arousable. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>It was a pleasure taking care of you while you were here at ___. You were admitted after being transferred from an outside hospital where you were taken after having an episode of unresponsiveness. You were also having severe back pain. An MRI of the back was performed which found no acute new lesions of the spine that would cause the back pain, but did find infiltration of the bone by myeloma. You had a CT scan of your head which was normal. You were seen by the oncology team who indicated that there was no indication to start systemic treatment. You had a chest CT scan which showed pneumonia and you were started on antibiotics with a planned course of 8 days, starting ___. A PICC line was placed so that you could be discharged with IV antibiotics.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild/Fever 2. Glargine 12 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 3. Apixaban 2.5 mg PO BID 4. Atorvastatin 20 mg PO QPM 5. Cyanocobalamin 1000 mcg PO DAILY 6. Ferrous Sulfate 325 mg PO DAILY 7. Gabapentin 600 mg PO DAILY 8. Lidocaine 5% Ointment 1 Appl TP DAILY 9. Lisinopril 10 mg PO DAILY 10. Senna 8.6 mg PO BID:PRN Constipation - First Line 11. Tamoxifen Citrate 20 mg PO DAILY 12. Torsemide 140 mg PO DAILY 13. Vitamin D 400 UNIT PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary Diagnoses ============== Acute influenza A infection Hypoxemia Hypernatremia Altered mental status Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you at ___ ___. WHY WAS I IN THE HOSPITAL? - You were having fevers. WHAT HAPPENED TO ME IN THE HOSPITAL? - You were diagnosed with acute influenza (the flu). - You were given medication to help reduce the severity/duration of your infection. - You had a CT scan of your brain, which was normal. - You were given intravenous fluids. WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? - Please take your medications and go to your follow up appointments as described in this discharge summary. - If you experience any of the danger signs listed below, please call your primary care doctor or go to the emergency department immediately. We wish you the best! Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aluminum-Magnesium Hydrox.-Simethicone ___ mL PO QID:PRN heartburn RX *alum-mag hydroxide-simeth 200 mg-200 mg-20 mg/5 mL 15 ML by mouth Every 6 hours Refills:*0 2. lansoprazole 30 mg oral DAILY RX *lansoprazole [Prevacid SoluTab] 30 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*0 3. Acetaminophen (Liquid) 650 mg PO Q6H:PRN Pain - Mild RX *acetaminophen 500 mg/5 mL 6.5 ml by mouth Every 6 hours Refills:*1 4. Bisacodyl 10 mg PO/PR DAILY:PRN c RX *bisacodyl 10 mg 1 suppository(s) rectally Daily Disp #*12 Suppository Refills:*0 5. Calcium Carbonate 500 mg PO QID:PRN heartburn RX *calcium carbonate 500 mg calcium (1,250 mg) 1 tablet(s) by mouth four times a day Disp #*100 Tablet Refills:*0 6. Fentanyl Patch 25 mcg/h TD Q72H RX *fentanyl 25 mcg/hour Apply 1 patch Every 72 hours Disp #*5 Patch Refills:*0 7. Hyoscyamine .25 mg PO QID:PRN esophageal secretions RX *hyoscyamine sulfate 125 mcg/5 mL 10 ml by mouth Four times a day Refills:*0 8. Lidocaine 5% Patch 1 PTCH TD QPM RX *lidocaine 5 % Apply 1 patch Every evening for 12 hours Disp #*15 Patch Refills:*0 9. LORazepam 1 mg PO Q8H:PRN anxiety RX *lorazepam 1 mg 1 mg by mouth Every 8 hours Disp #*21 Tablet Refills:*0 10. Morphine Sulfate (Oral Solution) 2 mg/mL 10 mg PO Q3HR:PRN Pain - Moderate Reason for PRN duplicate override: Alternating agents for similar severity RX *morphine 10 mg/5 mL 10 mg by mouth Every 3 hours Disp #*500 Milliliter Milliliter Refills:*0 11. Ondansetron ODT 8 mg PO Q8H:PRN Nausea RX *ondansetron 8 mg 1 tablet(s) by mouth Every 8 hours Disp #*90 Tablet Refills:*0 12. Polyethylene Glycol 17 g PO DAILY:PRN constipation RX *polyethylene glycol 3350 17 gram/dose 17 grams by mouth Daily Refills:*0 13. Prochlorperazine 10 mg PO Q8H:PRN Nausea RX *prochlorperazine maleate 10 mg 1 tablet(s) by mouth Every 8 hours Disp #*30 Tablet Refills:*0 14. Ramelteon 8 mg PO QHS Should be given 30 minutes before bedtime RX *ramelteon [Rozerem] 8 mg 1 tablet(s) by mouth Nightly Disp #*30 Tablet Refills:*0 15. Senna 8.6 mg PO BID RX *sennosides [senna] 8.6 mg 1 Tab by mouth twice a day Disp #*60 Tablet Refills:*0 16. Sucralfate 1 gm PO QID prn pain RX *sucralfate 1 gram/10 mL 10 ml by mouth four times a day Refills:*0 17. Sumatriptan Succinate 25 mg PO BID:PRN headache RX *sumatriptan succinate 25 mg 1 tablet(s) by mouth twice a day Disp #*5 Tablet Refills:*0 18. TraZODone 50 mg PO QHS:PRN insomnia RX *trazodone 50 mg 1 tablet(s) by mouth at bedtime Disp #*30 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Active: - Radiation esophagitis - Esophageal cancer s/p XRT - Nausea with Vomiting - GERD - Moderate Malnutrition Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure caring for you at ___ ___. You were admitted for treatment and evaluation of nausea, vomiting and fever shortly after discharge from a prolonged hospitalization for esophagitis due to treatment of your cancer. You were restarted on medications to treat your pain and nausea. You were evaluated by the Palliative Care team who helped to treat your pain. Please follow-up with your outpatient providers as instructed below. You have a follow up in 1 week with oncology. Please try to cut back on your opiates over the course of the upcoming week as discussed with the palliative care team. Try not to take more than 5 doses per day. Thank you for allowing us to participate in your care. All best wishes for your health. Sincerely, Your ___ medical team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr. ___, It was a pleasure caring for you at ___. You were admitted for management of infected fluid in your lung. You received an imaging study (CT Scan) that showed new pockets of infected fluid in your lung. A medication was placed in your chest tube to help release this fluid. You will continue your home antibiotics until your follow-up appointment with the Infectious Disease clinic. Please also follow-up with your lung doctors (___) on ___. Best wishes, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Atorvastatin 40 mg PO HS 3. Citalopram 10 mg PO QHS 4. Clopidogrel 75 mg PO DAILY 5. Finasteride 5 mg PO DAILY 6. Gabapentin 100 mg PO BID 7. Tolterodine 4 mg PO QHS 8. Vitamin D 1000 UNIT PO DAILY 9. Docusate Sodium 100 mg PO BID 10. Metoprolol Succinate XL 25 mg PO DAILY 11. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H RX *metronidazole [Flagyl] 500 mg 1 tablet(s) by mouth once Disp #*1 Tablet Refills:*0 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Aspiration ___ Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital after vomiting with aspiration and were treated with antibiotics with improvement in your symptoms. You experienced some confusion while in the hospital which improved. You were discharged to ___ for rehabilitation.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Artificial Tears ___ DROP BOTH EYES PRN dry eyes 2. Atorvastatin 40 mg PO QPM 3. Citalopram 20 mg PO DAILY 4. LeVETiracetam 1000 mg PO BID RX *levetiracetam [Keppra] 1,000 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 5. Metoprolol Succinate XL 25 mg PO DAILY 6. Warfarin 2 mg PO DAILY16 7. Outpatient Physical Therapy Please evaluate and treat. Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Subacute to Acute Stroke History of prior strokes Seizures Atrial Fibrillation Depression Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the ___ Inpaitient Neurology Service for an episode of being unable to speak correctly. You had a similar episode in ___. At that time, the MRI of your brain was negative for stroke. However, this time, your MRI showed a stroke in the left side of your brain in a part called the temporal lobe. We have continued your blood thiner, Coumadin, to help prevent further strokes. We have also continued your cholesterol lowering medication, Atorvastatin. We have also increased your seizure medication because we are unsure if your previous episode was a seizure and if you had a seizure preciptated by a stroke this time. Due to the possibility of seizures, do not drive for the next 6 months. Please follow up with your primary care doctor and your neurologist. Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Levothyroxine Sodium 75 mcg PO DAILY 2. Multivitamins W/minerals 1 TAB PO DAILY 3. Acetaminophen 650 mg PO Q6H:PRN pain 4. Amlodipine 2.5 mg PO DAILY 5. Apixaban 2.5 mg PO BID 6. CeftriaXONE 2 gm IV Q24H 7. Chlorhexidine Gluconate 0.12% Oral Rinse 15 mL ORAL TID 8. Docusate Sodium 100 mg PO BID 9. Polyethylene Glycol 17 g PO DAILY:PRN constipation 10. Senna 8.6 mg PO DAILY:PRN constipation 11. Sodium Chloride 0.9% Flush 10 mL IV DAILY and PRN, line flush 12. Sodium Chloride 0.9% Flush ___ mL IV DAILY and PRN, line flush 13. Zinc Sulfate 220 mg PO DAILY Duration: 10 Days Please continue through ___. Ascorbic Acid ___ mg PO DAILY Duration: 10 Days Please continue through ___. Heparin Flush (10 units/ml) 1 mL IV DAILY and PRN, line flush 16. Metoprolol Tartrate 12.5 mg PO BID Please hold for HR <60 or SBP <90 Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: Acute issues: #L elbow necrotizing fasciitis #A-fib with RVR #Sinus bradycardia #Supratherapeutic INR #new diagnosis systolic CHF #Leukocytosis #Normocytic anemia Chronic issues: #HTN Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you at ___. You were admitted after you injured your arm and it became infected. You were treated with antibiotics and had surgical removal of the infected tissue. We also adjusted the medications you are taking to prevent strokes. We are discharging you to rehab so that you can regain your strength. Take care, and we wish you the best. Sincerely, Your ___ medicine team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>___ Tumor Surgery • You underwent surgery to remove a ___ lesion from your ___. • You may shower at this time but keep your incision site as dry as possible. • It is best to keep your incision open to air but it is ok to cover it when outside. • Call your surgeon if there are any signs of infection like redness, fever, or drainage. Activity • We recommend that you avoid heavy lifting, running, climbing, or other strenuous exercise until your ___ appointment. • You make take leisurely walks and slowly increase your activity at your own pace once you are symptom free at rest. ___ try to do too much all at once. • No driving while taking any narcotic or sedating medication. • If you experienced a seizure while admitted, you are NOT allowed to drive by law. • No contact sports until cleared by your neurosurgeon. You should avoid contact sports for 6 months. Medications • Please do NOT take any blood thinning medication (Aspirin, Ibuprofen, Plavix, Coumadin) until cleared by the neurosurgeon. • You have been discharged on Keppra (Levetiracetam). This medication helps to prevent seizures. Please continue this medication as indicated on your discharge instruction. It is important that you take this medication consistently and on time. • You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. What You ___ Experience: • You may experience headaches and incisional pain. • You may also experience some ___ swelling around your face and eyes. This is normal after surgery and most noticeable on the second and third day of surgery. You apply ice or a cool or warm washcloth to your eyes to help with the swelling. The swelling will be its worse in the morning after laying flat from sleeping but decrease when up. • You may experience soreness with chewing. This is normal from the surgery and will improve with time. Softer foods may be easier during this time. • Feeling more tired or restlessness is also common. • Constipation is common. Be sure to drink plenty of fluids and eat a ___ diet. If you are taking narcotics (prescription pain medications), try an ___ stool softener. When to Call Your Doctor at ___ for: • Severe pain, swelling, redness or drainage from the incision site. • Fever greater than 101.5 degrees Fahrenheit • Nausea and/or vomiting • Extreme sleepiness and not being able to stay awake • Severe headaches not relieved by pain relievers • Seizures • Any new problems with your vision or ability to speak • Weakness or changes in sensation in your face, arms, or leg Call ___ and go to the nearest Emergency Room if you experience any of the following: • Sudden numbness or weakness in the face, arm, or leg • Sudden confusion or trouble speaking or understanding • Sudden trouble walking, dizziness, or loss of balance or coordination • Sudden severe headaches with no known reason</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Hydrochlorothiazide 12.5 mg PO DAILY 2. Glargine 34 Units Breakfast Insulin SC Sliding Scale using HUM Insulin 3. Lisinopril 40 mg PO DAILY 4. Omeprazole 20 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Primary 1. Hypertensive Emergency 2. Reduced Ejection Fraction Secondary 1. Diabetes Mellitus - Type 2, Insulin Dependent 2. Chronic Cough - Secondary to lisinopril 3. Hypertension 4. Hyperlipidemia 5. Gastroesophageal Reflux Disease Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Ms. ___, It was a pleasure meeting you during your hospitalization. You were admitted with forehead pain, blurry vision, and chest pain. Your symptoms came on very suddenly and seemingly improved with minimal interventions. Given that your blood pressure was very high during these symptoms, we believe that you experienced something called "hypertensive emergency", which means that your blood pressure was so high that it effected several different organs in your body. As your blood pressure decreased, your symptoms of improved. Because you had blurry vision, we performed a carotid ultrasound which was unremarkable. You had a stress test which showed that your heart is pumping less efficiently. You have been scheduled to see a cardiologist on discharge to discuss how this may be further managed. Your blood pressure improved without new medications.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 500 mg PO Q6H:PRN pain, fever 2. Aquaphor Ointment 1 Appl TP TID:PRN itchy skin 3. Citalopram 20 mg PO DAILY 4. Diltiazem Extended-Release 360 mg PO DAILY 5. Docusate Sodium 100 mg PO BID 6. Gabapentin 200 mg PO DAILY 7. Gabapentin 300 mg PO BID 8. HydrOXYzine 25 mg PO Q6H:PRN itcxhing 9. Isosorbide Mononitrate (Extended Release) 30 mg PO DAILY 10. Mupirocin Ointment 2% 1 Appl TP TID 11. Nephrocaps 1 CAP PO DAILY 12. Omeprazole 40 mg PO BID 13. OxycoDONE (Immediate Release) 5 mg PO Q8H:PRN pain 14. Sarna Lotion 1 Appl TP QID:PRN itchy ksin 15. Senna 8.6 mg PO BID:PRN constipation 16. sevelamer CARBONATE 2400 mg PO TID W/MEALS 17. TraZODone 50 mg PO HS:PRN insomnia 18. Albuterol Inhaler 2 PUFF IH Q4H:PRN wheezing 19. DuoNeb (ipratropium-albuterol) 0.5 mg-3 mg(2.5 mg base)/3 mL inhalation Q6H:PRN cough 20. ___ Tar (coal tar) 2 % topical HS 21. Nitroglycerin SL 0.4 mg SL PRN chest pain 22. Ondansetron 4 mg PO BID:PRN nausea/vomiting 23. Glargine 14 Units Breakfast Insulin SC Sliding Scale using lispro Insulin 24. CefTAZidime 2 g IV POST HD last dose to be given after dialysis on ___ 25. Guaifenesin ___ mL PO Q4H:PRN cough 26. Vancomycin 1000 mg IV HD PROTOCOL last dose to be given after dialysis on ___ Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: healthcare associated pneumonia Secondary: ESRD Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure to take care of you at ___. You were admitted with fevers and cough. You were treated with antibiotics with improvement in your symptoms. You should complete a course of antibiotics, which will be given at your dialysis sessions.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ascorbic Acid ___ mg PO BID RX *ascorbic acid (vitamin C) 250 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 2. Calcium Carbonate 1000 mg PO DAILY RX *calcium carbonate [Calcium 500] 500 mg calcium (1,250 mg) 2 tablet(s) by mouth once daily Disp #*60 Tablet Refills:*0 3. Polyethylene Glycol 17 g PO DAILY RX *polyethylene glycol 3350 [Miralax] 17 gram 1 packet by mouth once daily Disp #*30 Packet Refills:*0 4. Vitamin D 800 UNIT PO DAILY RX *ergocalciferol (vitamin D2) 400 unit 2 tablet(s) by mouth once a day Disp #*60 Tablet Refills:*0 5. Zinc Sulfate 220 mg PO DAILY Duration: 14 Days RX *zinc sulfate 220 mg (50 mg zinc) 1 capsule(s) by mouth once daily Disp #*14 Capsule Refills:*0 6. Glargine 14 Units Bedtime 7. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild/Fever 8. Albuterol Inhaler 2 PUFF IH Q6H:PRN dyspnea 9. Aspirin 81 mg PO DAILY 10. Atorvastatin 20 mg PO QPM 11. Bisacodyl ___AILY:PRN constipation 12. Fleet Enema (sodium phosphates) ___ gram/118 mL rectal DAILY:PRN 13. Fluticasone Propionate 110mcg 1 PUFF IH BID 14. GuaiFENesin 10 mL PO Q6H:PRN cough 15. Milk of Magnesia 30 mL PO DAILY:PRN constipation 16. Mirtazapine 15 mg PO QHS 17. Multivitamins W/minerals 1 TAB PO DAILY 18. Senna 8.6 mg PO DAILY 19. Sertraline 12.5 mg PO DAILY 20. Sodium Bicarbonate 650 mg PO BID heartburn 21. Sorbitol 30 mL PO DAILY:PRN constipation Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: ================== Primary Diagnosis ================== Lower GI bleed secondary to stercoral ulcer =================== Secondary Diagnosis =================== Anemia secondary to acute blood loss Ascending colon polyp Hypernatremia Constipation Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at ___ ___. Why was I in the hospital? - You had blood in your stool and required blood transfusions for low blood counts What was done while I was in the hospital? - You were given blood transfusions for low blood counts - A camera was used to check your GI tract for bleeding and you were found to have an ulcer in your colon which was likely the source of your bleeding. It was not bleeding so no further procedures needed to be done What should I do when I go home? - It is very important that you take your medications as prescribed - Please go to your scheduled appointment with your GI doctor and are seen by the primary doctor at your extended care facility. - If you have more blood in your stool and black tarry stool, please tell your primary doctor or go to the emergency room. Best wishes, Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Calcium Carbonate 500 mg PO QID:PRN heartburn 2. Levothyroxine Sodium 25 mcg PO DAILY 3. Atenolol 25 mg PO DAILY 4. Aspirin 81 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Gastroenteritis Mild demand ischemia Lower GI bleed Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were transferred to ___ for viral gastroenteritis. This improved, but you were also found to have some mild injury to your heart, some enlargement of your bile ducts, gallstones and sludge in your gallbladder, and also a GI bleed. The GI bleed resolved and you underwent endoscopy which showed diverticulosis which is the likely cause of bleed. The other issues can be examined as an outpatient. You will need some cardiac testing to evalute the health of your heart and an MRI of your liver to evaluate for the enlargement of your bile duct in the area of the left portion of your liver. You also had mildly elevated LFTs on the day prior to and after discharge. You should have repeat lipase and LFTs at your follow up appt.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium 100 mg PO BID 2. Enoxaparin Sodium 70 mg SC Q12H RX *enoxaparin 80 mg/0.8 mL 70 mg SC every twelve (12) hours Disp #*60 Syringe Refills:*0 3. HYDROmorphone (Dilaudid) 2 mg PO Q4H:PRN dyspnea RX *hydromorphone 2 mg 1 tablet(s) by mouth q4h prn Disp #*12 Tablet Refills:*0 4. Insulin SC Sliding Scale Fingerstick QACHS Insulin SC Sliding Scale using HUM Insulin 5. Ipratropium-Albuterol Neb 1 NEB NEB Q6H:PRN SOB 6. Multivitamins W/minerals 1 TAB PO DAILY 7. Pantoprazole 40 mg PO DAILY 8. Polyethylene Glycol 17 g PO DAILY 9. PredniSONE 80 mg PO DAILY 10. Senna 8.6 mg PO DAILY 11. Sodium Chloride Nasal ___ SPRY NU QID:PRN dry nose 12. Sulfameth/Trimethoprim SS 1 TAB PO DAILY 13. Aspirin 81 mg PO DAILY 14. FoLIC Acid 1 mg PO DAILY 15. Levothyroxine Sodium 100 mcg PO DAILY 16. Ondansetron 8 mg PO Q8H:PRN nausea 17. Prochlorperazine 10 mg PO Q6H:PRN nausea 18. Simvastatin 10 mg PO QPM 19. Vitamin D ___ UNIT PO DAILY 20. HELD- Dexamethasone 4 mg PO DAILY This medication was held. Do not restart Dexamethasone until you follow-up with your Oncologist. 21. HELD- Lisinopril 10 mg PO DAILY This medication was held. Do not restart Lisinopril until you f/u with your PCP ___: Extended Care Facility: ___ Discharge Diagnosis: Primary diagnosis: Drug induced pneumonitis Acute Hypoxic Respiratory Failure Secondary: Anxiety Pulmonary Embolism Metastatic Lung Adenocarcinoma Steroid-Induced Hyperglycemia Hyponatremia Leukocytosis Anemia Hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you at ___ ___. WHY WAS I IN THE HOSPITAL? - You were admitted to the hospital because you had fever, shortness of breath, and cough and were found to have a drug reaction called Pneumonitis. This was from the Pembrolizumab you received. WHAT HAPPENED TO ME IN THE HOSPITAL? - You received a breathing tube for several days to help you breathe. - You received steroids to decrease the inflammation in your lungs (pneumonitis) and a medicine called IVIG. - You were found to have a blood clot (pulmonary embolism) and you were started on blood thinners (anticoagulation). WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? - Continue to take all your medicines and keep your appointments. - Go to your appointment with your Oncologist. - Go to your appointment with the pulmonologists. - Follow-up with Palliative Care - if you are at rehab and are having difficulty finding a palliative care doctor for support, please contact Dr. ___ or contact Dr. ___ the number he left you in his card. We wish you the best! Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 10 mg PO DAILY 2. Hydrochlorothiazide 25 mg PO DAILY 3. Losartan Potassium 100 mg PO DAILY 4. Omeprazole 20 mg PO DAILY 5. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain RX *oxycodone 5 mg 1 tablet(s) by mouth every 4 hours Disp #*15 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: R SDH R olecranon fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity status: ambulatory- independent Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the ACS service for your injuries, which included bleeding in your head and an elbow fracture. You are ready to continue your recovery at home. Please resume all home medications. You may take tylenol or motrin for pain control and narcotic medication if needed, and only as directed. You can continue on a regular diet. You may resume all your usual activities. Keep your R elbow in a splint and keep the R arm as non-weight-bearing until you follow-up with orthopedic surgery. You may do passive range of motion exercises with that arm.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Simvastatin 10 mg PO DAILY 2. Furosemide 10 mg PO DAILY 3. Duloxetine 60 mg PO DAILY 4. Aripiprazole 2 mg PO DAILY 5. Acetaminophen 1000 mg PO Q8H 6. Levothyroxine Sodium 75 mcg PO DAILY 7. Docusate Sodium 100 mg PO BID 8. Ciprofloxacin HCl 250 mg PO Q12H 9. Losartan Potassium 50 mg PO DAILY 10. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Fall Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Symptomatic relief with ice packs or heating pads for short periods may ease the pain. Do NOT smoke. Return to the ED right away for any acute shortness of breath, increased pain or crackling sensation around your rips (crepitus). Narcotic pain medication can cause constipation. Therefore you should take a stool softener twice daily and increase your fluid and fiber intake if possible. If your doctor allows, non steriodal ___ drugs are very effective in controlling pain (i.e. Ibuprofen, Motrin, Advil, Aleve, Naprosyn) but they have their own set of side effects so make sure your doctor approves. Please abstain from taking Plavix until you follow up with Neurosurgery in clinic in 4 weeks. Please take a full liquid (non-chew) diet for the next two weeks or until you follow up with a dentist for definitive dental care regarding your tooth injury.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Allopurinol ___ mg PO DAILY 2. Atorvastatin 80 mg PO DAILY 3. Baclofen 10 mg PO TID as needed for pain 4. Carbamazepine (Extended-Release) 200 mg PO BID 5. Colchicine 0.6 mg PO EVERY OTHER DAY 6. Furosemide 20 mg PO DAILY 7. Gabapentin 300 mg PO MORNING, NOON 8. Gabapentin 1200 mg PO HS 9. Glargine 20 Units Bedtime 10. Metoprolol Tartrate 25 mg PO Q 8H 11. Tamsulosin 0.4 mg PO HS 12. Warfarin 7.5 mg PO DAILY16 afib, home med please adjust your coumadin dose according to your INR checks at ___ via Dr ___ 13. Zolpidem Tartrate 5 mg PO HS insomnia **** INSTRUCTED TO CONTINUE ALL HOME MEDS UNLESS INSTRUCTED OTHERWISE BY PCP*** Discharge Disposition: Home Discharge Diagnosis: Transient Ischemic Attack Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>You were admitted for symptoms of left hand and leg weakness which had resolved prior to your arrival. Your head imaging was negative for stroke, so you likely had a "TIA" which stands for transient ischemic attack. Please follow up with your Atrius doctor and have him set you up with an Atrius Neurologist for follow up. We have not changed any of you medications so you should continue to take all of your home medications as instructed by your primary doctor.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 5 mg PO DAILY RX *amlodipine 5 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 2. Tamsulosin 0.4 mg PO QHS RX *tamsulosin 0.4 mg 1 capsule(s) by mouth at bedtime Disp #*30 Capsule Refills:*0 3. Ferrous Sulfate 325 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS - obstructive uropathy SECONDARY DIAGNOSES - hypertension Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure to meet you and your family. You were admitted because you were confused. This was because your prostate was blocking urine from leaving your bladder and so your electrolytes and toxins were building up in your body. You had dialysis to improve your electrolyte balance, and placed a foley catheter to drain the urine. You were feeling better, and were able to be discharged. You will need to follow-up with the urology team to talk about the next steps so that this does not happen again. Please see below for more information about any changes made to your medications. Again, it was very nice to meet you, and we wish you the best. Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. DME Straight cane dx: CAD, s/p CABG prognosis: good length of need: 13 months 2. Aspirin 81 mg PO DAILY 3. Atorvastatin 80 mg PO QPM 4. Carvedilol 6.25 mg PO BID RX *carvedilol 6.25 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*1 5. Furosemide 40 mg PO DAILY RX *furosemide [Lasix] 40 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*1 6. HydrALAZINE 10 mg PO Q8H RX *hydralazine 10 mg 1 tablet(s) by mouth every eight (8) hours Disp #*60 Tablet Refills:*1 7. Humalog ___ 30 Units Breakfast Humalog ___ 14 Units Dinner 8. Sertraline 150 mg PO DAILY 9. Docusate Sodium 100 mg PO BID Duration: 2 Weeks 10. HYDROmorphone (Dilaudid) ___ mg PO Q3H:PRN pain RX *hydromorphone [Dilaudid] 2 mg ___ tablet(s) by mouth q 3 hours Disp #*60 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Coronary Artery Disease Discharge Condition: Alert and oriented x3 nonfocal Ambulating with steady gait Incisional pain managed with Incisions: Sternal - healing well, no erythema or drainage Leg Right - healing well, no erythema or drainage. Edema trace Followup Instructions: ___ [/INST] </s><s>Please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. Look at your incisions daily for redness or drainage Please NO lotions, cream, powder, or ointments to incisions Each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart No driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive No lifting more than 10 pounds for 10 weeks Please call with any questions or concerns ___ Females: Please wear bra to reduce pulling on incision, avoid rubbing on lower edge **Please call cardiac surgery office with any questions or concerns ___. Answering service will contact on call person during off hours**</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Bisacodyl 10 mg PO DAILY:PRN c RX *bisacodyl 5 mg 2 tablet(s) by mouth daily Disp #*30 Tablet Refills:*3 2. Jevity 1.5 Cal (lactose-reduced food with fibr) 240 ml can oral ASDIR 1 can (240 mL) five times daily RX *lactose-reduced food with fibr [___ 1.5 Cal] 0.06 gram-1.5 kcal/mL 1 can G tube ASDIR Disp ___ Milliliter Milliliter Refills:*0 3. LORazepam 0.5 mg PO TID:PRN nausea try reglan (metoclopramide) first RX *lorazepam 0.5 mg 1 tablet by mouth three times a day Disp #*10 Tablet Refills:*0 4. Metoclopramide 10 mg PO QIDACHS RX *metoclopramide HCl 10 mg 1 tablet by mouth four times a day Disp #*90 Tablet Refills:*3 5. Multivitamins W/minerals 1 TAB PO DAILY RX *multivitamin,tx-minerals [Vitamins and Minerals] 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*3 6. Nystatin Oral Suspension 5 mL PO QID:PRN thrush RX *nystatin 100,000 unit/mL 5 mL by mouth four times a day Refills:*3 7. Polyethylene Glycol 17 g PO BID RX *polyethylene glycol 3350 [Miralax] 17 gram 1 powder(s) by mouth twice daily Disp #*30 Packet Refills:*3 8. Senna 8.6 mg PO QHS RX *sennosides [senna] 8.6 mg 1 tab by mouth every night Disp #*30 Tablet Refills:*3 9. OxyCODONE SR (OxyconTIN) 20 mg PO Q12H RX *oxycodone [OxyContin] 20 mg 1 tablet(s) by mouth every 12 hours Disp #*30 Tablet Refills:*0 10. OxyCODONE (Immediate Release) 5 mg PO Q6H:PRN BREAKTHROUGH PAIN 11. Ranitidine 75 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY: Squamous cell carcinoma of the soft palate, uvula and tonsils, moderate malnutrition, Dehydration, anxiety SECONDARY: Pancytopenia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was our pleasure caring for you at ___ ___. You were admitted to the hospital with dehydration and malnutrition. After discussion with your outpatient oncologist, radiation oncologist and family, the decision was made to place a device called a "percutaneous enteral gastrostomy tube," or G-tube, for providing nutrition until you complete your course of radiation and chemotherapy. You were started on continuous tube feeds which you tolerated well, and then you were transitioned to bolus tube feeds. We also increased your dose of oxycontin to better control your pain, and we started two new medications for nausea (reglan, also called metoclopramide, and ativan, also called lorazepam). When you go home, you are going to administer 1 can of Jevity 1.5 through your G-tube five times per day. You will have a visiting nurse who will help you to do this at home, and your family will also assist you. Thank you for allowing us to participate in your care.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ciprofloxacin HCl 500 mg PO Q12H Duration: 3 Days last day last ___ in the am 2. Docusate Sodium 100 mg PO BID:PRN constipation 3. Senna 17.2 mg PO QHS:PRN constipation 4. Acetaminophen 650 mg PO Q8H:PRN Pain - Mild 5. BuPROPion 150 mg PO BID 6. FoLIC Acid 1 mg PO DAILY 7. Ipratropium-Albuterol Neb 1 NEB NEB Q6H 8. Levothyroxine Sodium 25 mcg PO DAILY 9. Scopolamine Patch 1 PTCH TD Q72H 10. Tamsulosin 0.4 mg PO QHS 11. Thiamine 100 mg PO DAILY 12. TraMADol 50 mg PO Q6H:PRN Pain - Moderate 13. TraZODone 25 mg PO QHS 14. TraZODone 25 mg PO Q6H:PRN anxiety / agitation 15. HELD- Atorvastatin 20 mg PO QPM This medication was held. Do not restart Atorvastatin until you have your liver enzymes rechecked in about 1 week Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: gallstone pancreatitis choledocholithiasis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Mr. ___: It was a pleasure caring for you at ___. You were admitted with a gallstone blocking your biliary duct, and inflammation in your pancreas (pancreatitis). You were seen by GI specialists and underwent a special kind of endoscopy (ERCP) where a stone was removed from your gallbladder. You will need to take an antibiotic called cipro for 5 days after your ERCP and to see the surgery team in clinic to discuss options for gallbladder removal surgery.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN pain 2. Docusate Sodium 100 mg PO BID 3. Heparin Flush (10 units/ml) 2 mL IV DAILY and PRN, line flush 4. nafcillin 2 gram injection Q 4 hrs thru ___ RX *nafcillin 2 gram 2 Gm IV every four (4) hours Disp #*38 Vial Refills:*0 5. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every six (6) hours Disp #*40 Tablet Refills:*0 6. Metoprolol Tartrate 25 mg PO BID RX *metoprolol tartrate 25 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*2 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: MSSA anterior mediastinal abscess Acute renal failure Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>* You were admitted to the hospital for evaluation of your chest and back pain which ultimately was due to an infected mass ___ your anterior mediastinum. You eventually required surgery and you've recovered well. You are now ready for discharge but will need antibiotics at home until ___. The Infectious Disease service will continue to follow you as an out patient. * Continue to use your incentive spirometer 10 times an hour while awake. * Check your incisions daily and report any increased redness or drainage. Cover the area with a gauze pad if it is draining. * You will continue to need pain medication once you are home but you can wean it over a few weeks as the discomfort resolves. Make sure that you have regular bowel movements while on narcotic pain medications as they are constipating which can cause more problems. Use a stool softener or gentle laxative to stay regular. * No driving while taking narcotic pain medication. * Take Tylenol ___ mg every 6 hours ___ between your narcotic. * Continue to stay well hydrated and eat well to heal your incisions. * Your kidney function was initially abnormal probably due to the use of Ibuprofen prior to admission and multiple contrast studies while hospitalized. Your kidney function is improving daily but you cannot take Ibuprofen and should not have any studies with contrast until your kidneys have time to heal and function properly. It is important for your kidneys to stay well hydrated too. * Shower daily. Wash incision with mild soap & water, rinse, pat dry * No tub bathing, swimming or hot tubs until incision healed * No lotions or creams to incision site * Walk ___ times a day and gradually increase your activity as you can tolerate. Call Dr. ___ ___ if you experience: -Fevers > 101 or chills -Increased shortness of breath, chest pain or any other symptoms that concern you.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atenolol 100 mg PO DAILY 2. CloniDINE 0.2 mg PO BID 3. Hydrochlorothiazide 25 mg PO DAILY 4. Thiamine 100 mg PO DAILY RX *thiamine HCl 100 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 5. FoLIC Acid 1 mg PO DAILY RX *folic acid 1 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 6. Ranitidine 75 mg PO DAILY RX *ranitidine HCl [Acid Control] 75 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 7. Polyethylene Glycol 17 g PO DAILY RX *polyethylene glycol 3350 [ClearLax] 17 gram/dose 17 g by mouth daily Disp #*30 Packet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: primary: constipation, abdominal pain, possible alcohol gastritis secondary: alcohol abuse Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You came to the hospital because of chest pain and abdominal pain. You had imaging done of your abdomen which showed you are constipated. It is most likely your abdominal pain is from constipation and also from drinking alcohol. We recommend you stop drinking alcohol, follow up with your primary care doctor ___ below for appointment times). You may need a scope (a camera that goes down your throat to look at your stomach) to see if you have any inflammation of your stomach from alcohol</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Clobazam 20 mg PO QHS 2. LamoTRIgine 400 mg PO BID mitochondrial seizure disorder 3. TraZODone ___ mg PO QHS:PRN insomnia 4. ZOLMitriptan 5 mg nasal ASDIR 5.Outpatient Physical Therapy Cervical musculoskeletal pain Discharge Disposition: Home Discharge Diagnosis: Headache Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr. ___, You were admitted to the neurology service for symptoms of left arm weakness which was concerning for stroke. Your brain MRI was normal and did not show any stroke or other abnormalities. On examination, you did not have physiologic weakness. We recommended a cervical soft-collar for your neck pain which was exacerbating your headache. You were seen by physical therapy who recommended outpatient ___. Please follow-up with Dr. ___ as already scheduled. Best, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 5 mg PO DAILY 2. Atenolol 50 mg PO DAILY 3. Chlorthalidone 50 mg PO DAILY 4. colestipol 2 grams oral daily 5. Levothyroxine Sodium 75 mcg PO DAILY 6. Glargine 26 Units Bedtime Insulin SC Sliding Scale using Novolog Insulin Discharge Disposition: Home Discharge Diagnosis: Portal vein thrombosis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, ___ was a pleasure taking care of you here at ___. You were admitted to the hospital for a clot in a blood vessel in your liver called the portal vein. You were evaluated by the liver specialists who do not feel you need blood thinners for this. We recommend that you followup with the liver tumor clinic to further discuss treatment of your liver cancer.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Atorvastatin 40 mg PO DAILY 3. Fluoxetine 10 mg PO DAILY 4. Repaglinide 0.5 mg PO TIDAC 5. Lorazepam 0.5 mg PO BID PRN vertigo 6. Restasis (cycloSPORINE) 0.05 % ophthalmic BID left eye 7. Dorzolamide 2%/Timolol 0.5% Ophth. 1 DROP LEFT EYE BID 8. Brimonidine Tartrate 0.15% Ophth. 1 DROP LEFT EYE Q8H 9. Outpatient Physical Therapy ICD-9-CM 438.85 Vertigo Will need ___ rehab. Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: chronic vertigo, cervical stenosis, macular degeneration Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were hospitalized due to worsening unsteadiness and dizziness. These symptoms represent a worsening of your chronic vertigo due to your right ear surgery. As you were found to have decreased vibration and position sense in your legs, we also checked a cervical spine MRI. This did show some degenerative changes (arthritis) in your neck and narrowing of the spinal canal, but there was no compression. Physical therapy worked with you in the hospital and recommended discharge home with outpatient ___ rehab and physical therapy. You have a prescription for this. Please call the numbers for home care services. Please follow-up with your primary care doctor within 1 week.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. heparin (porcine) 5,000 unit/mL Solution Sig: One (1) injection Injection TID (3 times a day). 2. aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 3. atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. fluoxetine 20 mg Capsule Sig: One (1) Capsule PO DAILY (Daily). Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Right middle cerebral artery stroke. Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Lethargic but arousable. Activity Status: Out of Bed with assistance to chair or wheelchair. . Neuro examination at discharge: Patient demonstrated wakefulness, attention, and improved speech daily. She remains hemiplegic on the left with no movement on the L side even to noxious stimuli. There is a left facial droop. Reflexes are brisk, and upgoing on the left plantar. She is inattentive to her left side. Mentation and mood are off for the circumstance. Followup Instructions: ___ [/INST] </s><s>Dear ___, You were admitted to ___ after imaging done at your local ___ showed that you had suffered a large stroke. The stroke was in the middle cerebral artery in your brain on the right side. This is a very serious medical condition, and your recovery will likely be a long one, but since you are so young, your prognosis to regain some functioning is very good. . It is very important that you take all of your medications as prescribed especially the aspirin. Additionally, you MUST stop smoking. It places you at a very high risk of having another stroke. People who are trying to quit smoking have the best success when they surround themselves with supportive people who also do not smoke. If you need a Nicotine patch, Nicorette gum, or other nicotine supplements, please ask your doctor at rehab to help you attain some. . When you were medically stable to leave the hospital, you were discharged to a rehab facility where you can have more intensive physical, occupational, and speech therapy. . It was very nice to meet you and your family. We wish you the very best in your recovery.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atorvastatin 80 mg PO QPM RX *atorvastatin 80 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 2. PredniSONE 20 mg PO DAILY Duration: 3 Doses RX *prednisone 10 mg 2 tablet(s) by mouth daily Disp #*6 Tablet Refills:*0 3. PredniSONE 10 mg PO DAILY Duration: 2 Days 4. Acetaminophen 325-650 mg PO Q6H:PRN Pain - Mild 5. Albuterol Inhaler 2 PUFF IH Q6H:PRN wheezing 6. Aspirin 81 mg PO DAILY 7. FLUoxetine 40 mg PO DAILY 8. FoLIC Acid 1 mg PO DAILY 9. Levothyroxine Sodium 75 mcg PO DAILY 10. Metoprolol Succinate XL 25 mg PO DAILY 11. Multivitamins 1 TAB PO DAILY 12. Nicotine Patch 21 mg TD DAILY 13. Symbicort (budesonide-formoterol) 160-4.5 mcg/actuation inhalation 2 puffs BID for wheezing 14. Thiamine 100 mg PO DAILY 15. Tiotropium Bromide 1 CAP IH DAILY Discharge Disposition: Home Discharge Diagnosis: - Moderate to severe stenosis of bio-prosthetic aortic valve - Non-ST segment elevation myocardial infarction - Chronic obstructive pulmonary disease - Depression - Hypothyroidism - Leukocytosis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, WHY WERE YOU ADMITTED? - You had chest pain and shortness of breath WHAT WAS DONE? - You were observed while exercising to see how well your heart could handle it - We found that your valve that was replaced recently has become narrowed and is the reason for your symptoms WHAT TO DO WHEN YOU LEAVE THE HOSPITAL? - Please follow up with your doctor appointments as listed below - Your outpatient cardiologist (heart doctor) will tell you the next steps to fixing your valve - If you have the SAME chest pain (that hurts when you push on it), you can take Tylenol Extra-Strength 2 tablets (1,000 mg) every 8 hours as needed. - If you have any NEW chest pain or chest pressure, shortness of breath, or sudden weight gain, please call a doctor. It was a pleasure taking care of you, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Tamsulosin 0.4 mg PO HS 2. PredniSONE 5 mg PO DAILY 3. Pravastatin 10 mg PO DAILY 4. Nephrocaps 1 CAP PO DAILY 5. Lisinopril 5 mg PO DAILY 6. Glargine 7 Units Breakfast 7. Furosemide 120 mg PO DAILY 8. Clopidogrel 75 mg PO DAILY 9. Acetaminophen 650 mg PO Q6H:PRN pain Discharge Disposition: Home Discharge Diagnosis: Abdominal pain, diarrhea Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the transplant surgery service for observation in the setting of increased abdominal pain and diarrhea. Your pain resolved shortly after admission and you are tolerating your tube feeds without pain or nausea. Your stool was checked for infection and was negative and your diarrhea has also resolved. You are safe to return home and continue your tube feed and dialysis regimen. If you experience worsening abdominal pain, nausea, vomiting, fevers, chills, significant diarrhea, or other symptoms that concern you please call the Transplant Surgery Office at ___.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q8H:PRN pain 2. Amlodipine 10 mg PO DAILY 3. Captopril 50 mg PO TID 4. Digoxin 0.125 mg PO DAILY 5. Dipyridamole-Aspirin 1 CAP PO BID 6. Ferrous Sulfate 325 mg PO DAILY 7. Metoprolol Succinate XL 200 mg PO DAILY 8. Multivitamins 1 TAB PO DAILY 9. Simvastatin 10 mg PO DAILY 10. Vitamin D 800 UNIT PO DAILY 11. Amitriptyline 25 mg PO HS 12. Clonazepam 0.25 mg PO QHS:PRN insomnia This medication will be tapered and discontinued as an outpatient. 13. GlipiZIDE XL 2.5 mg PO DAILY 14. Milk of Magnesia 30 mL PO DAILY:PRN constipation Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnosis: Confusion, self-resolved, possibly medication effect Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you during your hospitalization. You were admitted on ___ after you were found to be fatigued and a little confused. You underwent an evaluation including physical exams, blood tests, and CT scan of the head. Based on this work-up, there were no worrisome findings. Your symptoms were most likely due to medications. We have changed around some of the medicines to try to help prevent this from happening in the future. If you begin to experience any worrisome symptoms such as confusion, dizziness, lightheadedness, falls, or any other concerning symptoms, please call your doctor right away.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. acyclovir 200 mg Capsule Sig: One (1) Capsule PO Q12H (every 12 hours). 2. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO once a day. 3. brimonidine 0.15 % Drops Sig: One (1) Drop Ophthalmic three times a day. 4. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. cyclosporine 0.05 % Dropperette Sig: One (1) Dropperette Ophthalmic daily (). 6. dorzolamide-timolol ___ % Drops Sig: One (1) Drop Ophthalmic twice a day. 7. famotidine 20 mg Tablet Sig: One (1) Tablet PO once a day. 8. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. heparin (porcine) 5,000 unit/mL Solution Sig: One (1) Injection TID (3 times a day). 10. hydrocortisone-pramoxine ___ % Cream Sig: One (1) Topical once a day as needed for itching. 11. latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at bedtime). 12. levothyroxine 112 mcg Tablet Sig: One (1) Tablet PO EVERY OTHER DAY (Every Other Day): MWF ___. 13. levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO EVERY OTHER DAY (Every Other Day): ___, Th, ___. 14. lipase-protease-amylase 12,000-38,000 -60,000 unit Capsule, Delayed Release(E.C.) Sig: ___ Caps PO TID W/MEALS (3 TIMES A DAY WITH MEALS). 15. methazolamide 50 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 16. prednisone 5 mg Tablet Sig: One (1) Tablet PO once a day. 17. sirolimus 1 mg Tablet Sig: 1.5 Tablets PO q am. 18. tacrolimus 1 mg Capsule Sig: Three (3) Capsule PO twice a day. 19. travoprost 0.004 % Drops Sig: One (1) drop Ophthalmic once a day. 20. trazodone 50 mg Tablet Sig: 0.5 Tablet PO at bedtime as needed for insomnia. 21. triamcinolone acetonide 0.1 % Cream Sig: One (1) Topical once a day: apply to itchy skin, no longer than 2 wks at a time. 22. gabapentin 300 mg Capsule Sig: One (1) Capsule PO Q48H (every 48 hours) as needed for peripheral neuropathy. 23. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 24. Citracal + D 315-200 mg-unit Tablet Sig: One (1) Tablet PO twice a day. 25. senna 8.6 mg Capsule Sig: Two (2) Capsule PO at bedtime: hold for loose stool. 26. ceftazidime 1 gram Recon Soln Sig: ___ g Intravenous with dialysis for 9 days: Pt is to receive ___ w/ HD until ___. Disp:*qs g* Refills:*0* 27. sevelamer carbonate 800 mg Tablet Sig: Two (2) Tablet PO TID W/MEALS (3 TIMES A DAY WITH MEALS). 28. insulin regular human 100 unit/mL Solution Sig: as directed Injection four times a day. Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: E coli septicemia (suspected HD line infection) Secondary: s/p pancreas and renal transplant chronic renal failure diastolic and systolic congestive heart failure severe mitral regurgitation peripheral neuropathy glaucoma Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital for fevers and rigors during dialysis. You were found to have a bacterial infection in your blood and were started on broad-spectrum antibiotics. You then became septic, had low blood pressure, and were transferred briefly to the ICU, where you were given fluids and started on high-dose steroids. Your dialysis line was also pulled because it may have been the cause of your infection. Your urine did not show any sign of infection, nor did your chest X-ray. Your echocardiogram did not show any signs of endocarditis, but your prior mitral regurgitation has worsened to severe and your pulmonary hypertension is also worse. When you first came, you developed right leg pain of unclear etiology. This may have been due to low blood pressure from sepsis worsening your baseline poor leg perfusion from your peripheral vascular disease. You also developed some shortness of breath, likely because you were fluid overloaded. Your symptoms resolved after you had a new dialysis catheter placed and were dialyzed. Your blood cultures eventually grew E coli. You were initially treated with meropenem, but this was switched to ceftazidime with hemodialysis to avoid putting another line and potential source of infection. Although you had a potential drug reaction to a cephalosporin causing neutropenia, our infectious disease experts felt that treatment with ceftazidime was the preferred option due to your brief treatment course of 2 weeks, no need of another line, and no renal toxicity (as with gentamicin). Your blood levels will be closely monitored to ensure that you do not develop neutropenia. Your stool sample was negative for C diff infection. We have made the following changes to your medications: -START ceftazidime 2g/2g/3g with hemodialysis until ___. -INCREASE sevelamer to 1600mg three times daily with meals Please continue to take your other medications as previously prescribed.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ciprofloxacin HCl 500 mg PO Q12H RX *ciprofloxacin [Cipro] 500 mg 1 tablet(s) by mouth twice a day Disp #*26 Tablet Refills:*0 2. Phenazopyridine 100 mg PO TID Duration: 3 Days It may turn your urine orange. You can only take this for three days RX *phenazopyridine [Uristat] 95 mg 1 tablet(s) by mouth three times a day Disp #*9 Tablet Refills:*0 3. Orsythia (levonorgestrel-ethinyl estrad) 0.1-20 mg-mcg oral daily 4. Promethazine 12.5 mg PO Q6H:PRN nausea RX *promethazine 12.5 mg 1 tablet(s) by mouth three times a day Disp #*10 Tablet Refills:*0 5. Acetaminophen w/Codeine ___ TAB PO Q6H:PRN pain It may make you drowsy RX *acetaminophen-codeine [Tylenol-Codeine #3] 300 mg-30 mg 1 tablet(s) by mouth every 6 hours as needed for pain Disp #*10 Tablet Refills:*0 RX *acetaminophen-codeine [Tylenol-Codeine #3] 300 mg-30 mg ___ tablet(s) by mouth every 6 hours Disp #*15 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Pyelonephritis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to ___ because of pain in your abdomen and nausea and vomiting. You were diagnosed with pyelonephritis (infection of the kidneys that occurs because the urine is infected). Please finish a 14 day course of antibiotics for this. Also, you may take the medication pyridium for up to three days to help with symptoms of bladder spasm. I have also given you a prescription for medication for nausea in case you need something. You may also take tylenol with codeine for your back pain from your kidney infection. Your antibiotics reduce the efficacy of your birth control pills in their ability to prevent pregnancy; if you are sexually active for the rest of this pack of pills make sure that your partner uses a condom.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. DiphenhydrAMINE 50 mg PO Q6H:PRN Insomnia 2. Famotidine 20 mg PO DAILY 3. LamoTRIgine 150 mg PO QHS 4. LevETIRAcetam 1000 mg PO QHS 5. Viokace (lipase-protease-amylase) 20,880-78,300- 78,300 unit oral TID W/MEALS Discharge Disposition: Home Discharge Diagnosis: Active: - Acute idiopathic pancreatitis - Chronic Pancreatic Insufficiency Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Ms ___, It was a pleasure treating you during this hospitalization. You were admitted for pancreatitis. You were seen by the Pancreas doctors and ___ surgery. With time and conservative care your pancreatitis resolved and by discharge you were tolerating a regular diet.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN pain 2. Acyclovir 400 mg PO Q8H Duration: 6 Days RX *acyclovir 400 mg 1 tablet(s) by mouth every eight (8) hours Disp #*12 Tablet Refills:*0 3. CeftriaXONE 2 gm IV Q 24H RX *ceftriaxone in dextrose,iso-os 2 gram/50 mL 2 gm IV Q24h Disp #*6 Intravenous Bag Refills:*0 4. PredniSONE 10 mg PO ONCE Duration: 1 Dose 30mg ___, 20mg ___, 10mg ___ Tapered dose - DOWN RX *prednisone 10 mg ___ tablet(s) by mouth daily Disp #*1 Tablet Refills:*0 5. Pantoprazole 40 mg PO Q12H RX *pantoprazole 40 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary diagnosis: Pasteurella epiglottitis Pasteurella bacteremia Primary herpes simple I infection Secondary diagnosis: Hypothyroidism Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you during your stay at ___ ___. You were admitted with throat pain and were found to have epiglottis and a blood stream infection caused by the bacteria, Pasteurella. We believe your dog transmitted this infection to you. You were initially admitted to the ICU and required a breathing tube. After treatment with antibiotics, you improved and transitioned to the general medicine floor. Our infectious disease colleagues evaluated you and recommended a 14 day course of ceftriaxone, an IV medication. You should have home infusions of this medication daily through ___. You were also found to have a primary herpes simplex I infection of your mouth. You were started on acyclovir, which you should continue to take for a total of 7 days (day 1: ___, day 7: ___. You should follow-up with the ear, nose, and throat doctor, ___. ___ in ___ weeks. Please call ___ to make an appointment. You have an appointment with your PCP, ___, ___ for ___ at 9:20am. Please take care, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler ___ PUFF IH Q4H:PRN SOB 2. Fluticasone Propionate NASAL 1 SPRY NU DAILY 3. Multivitamins 1 TAB PO DAILY 4. beclomethasone dipropionate 80 mcg/actuation inhalation BID:PRN SOB 5. Betamethasone Dipro 0.05% Cream 1 Appl TP BID:PRN hand rash 6. Sulfameth/Trimethoprim DS 1 TAB PO BID Duration: 14 Days RX *sulfamethoxazole-trimethoprim 800 mg-160 mg 1 tablet(s) by mouth twice a day Disp #*28 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: left third finger flexor tenosynovitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted for pain and swelling of your left hand. You were seen by the hand surgery team. You were put on IV antibiotics and your symptoms improved. You had a possible allergic reaction or side effect to Vancomycin which caused tingling in your throat. Please continue antibiotics and follow-up in the hand surgery clinic as scheduled.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Outpatient Lab Work please check INR on ___ and fax results to: Name: ___. Location: ___ Address: ___, ___ Phone: ___ Fax: ___ and ___ clinic Fax: ___ 2. Sulfameth/Trimethoprim DS 1 TAB PO BID RX ___ 800 ___ mg 1 (One) tablet(s) by mouth twice a day Disp #*16 Tablet Refills:*0 3. Atenolol 100 mg PO DAILY 4. Doxycycline Hyclate 100 mg PO Q12H 5. Finasteride 5 mg PO DAILY 6. Warfarin 2.5 mg PO DAILY16 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Syncope Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr ___, You were admitted to the hospital because of a fall. You evaluation showed no heart attack, stroke, bleeding in your brain, or abnormal heart rhythm as the cause of your fall. Your fall was likely related to a urinary tract infection, for which you will need to complete a course of antibiotics. You were evaluated by ___, who felt that you would benefit from home ___.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. enalapril maleate 10 mg Tablet Sig: Four (4) Tablet PO DAILY (Daily). 2. hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO DAILY (Daily). 3. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for pain. 4. oxycodone 5 mg Tablet Sig: ___ Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*24 Tablet(s)* Refills:*0* 5. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) as needed for constipation. 6. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. Discharge Disposition: Home Discharge Diagnosis: Appendicitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital with appendicitis requiring an operation to remove your appendix. You are being discharged to home with the following instructions: You are being discharged on medications to treat the pain from your operation. These medications will make you drowsy and impair your ability to drive a motor vehicle or operate machinery safely. You MUST refrain from such activities while taking these medications. Please call your doctor or return to the emergency room if you have any of the following: * You experience new chest pain, pressure, squeezing or tightness. * New or worsening cough or wheezing. * If you are vomiting and cannot keep in fluids or your medications. * You are getting dehydrated due to continued vomiting, diarrhea or other reasons. Signs of dehydration include dry mouth, rapid heartbeat or feeling dizzy or faint when standing. * You see blood or dark/black material when you vomit or have a bowel movement. * You have shaking chills, or a fever greater than 101.5 (F) degrees or 38(C) degrees. * Any serious change in your symptoms, or any new symptoms that concern you. * Please resume all regular home medications and take any new meds as ordered. Activity: No heavy lifting of items ___ pounds for 6 weeks. You may resume moderate exercise at your discretion, no abdominal exercises. Wound Care: You may shower, no tub baths or swimming. If there is clear drainage from your incisions, cover with clean, dry gauze. Your steri-strips will fall off on their own. Please remove any remaining strips ___ days after surgery. Please call the doctor if you have increased pain, swelling, redness, or drainage from the incision sites.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr. ___, You were found down unresponsive on the side walk after drinking alcohol and taking suboxone. You required support of your breathing because of this. It is very important that you do not take this combination of medications again in the future as it can make you stop breathing and kill you. We are happy that you improved and are ok. It was a pleasure being involved in your care. Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Doxycycline Hyclate 100 mg PO Q12H RX *doxycycline hyclate 100 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*24 Tablet Refills:*0 2. Atorvastatin 10 mg PO QPM 3. budesonide-formoterol 160-4.5 mcg/actuation inhalation BID 4. Caltrate 600 + D (calcium carbonate-vitamin D3) 600 mg (1,500 mg)-800 unit oral DAILY 5. Fish Oil (Omega 3) 1000 mg PO DAILY 6. Multivitamins 1 TAB PO DAILY 7. Ranitidine 150 mg PO BID 8. Pantoprazole 40 mg PO Q12H RX *pantoprazole 40 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*60 Tablet Refills:*0 9. Outpatient Lab Work Please draw CBC + diff on ___ and fax results to Dr. ___ ___ at ___. ICD 9: ___ Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: anaplasma lymphadenopathy Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was our pleasure participating in your care. You were admitted on ___ after being found to have blood in your stool. You were found to have low blood and platelet counts but fortunately did not need any blood transfusions. On evaluation of your low counts, you were found to have large abdominal lymph nodes concerning for lymphoma. You were also found to have an infection, called anaplasmosis, for which you were started on an antibiotic. . You also underwent bone marrow biopsy. The results of this are currently pending. You will be called when these results are finalized. Your platelets have remained low and puts you at risk for bleeding. Please let your doctor know if you develop any headaches, bleeding of your gums or nose bleeds or other episodes of black stool or bleeding. You will need to get your blood drawn on ___ to check your blood count. Again, it was our pleasure participating in your care, Your ___ Team</s>